virgola82
Forum Guru
Topics: 85
Posts: 348
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I came by this scheme of drugs of choice for htn when comorbities are present. It comes from guidelines.gov. I thought it could be useful to someone.
Patient Comorbidity or Demographics Which Represent Indications for Drug
Therapy Modification
· Isolated systolic hypertension -- Start with diuretic (hydrochlorothiazide
[HCTZ] 25 mg daily [QD]).
· Angina pectoris -- Start with beta blocker (Atenolol, Metoprolol), then calcium
channel antagonist (CCA) (Verapamil, Diltiazem).
· Congestive heart failure (CHF) or ejection fraction <40% -- Start with
angiotensin-converting enzyme (ACE) inhibitor (should be used even if on
diuretic already).
· Diabetes mellitus -- Start with ACE inhibitor (Enalapril). Maintain blood
pressure (BP) <130/80.
· Renal insufficiency -- (Serum creatinine [Scr] >2.5 mg/dL) -- Start with a
loop diuretic (furosemide), beta-blocker or CCA (Verapamil and Diltiazem
preferred); ACE inhibitor use is a relative contraindication in ACE inhibitor
naive patient. Maintain blood pressure <130/85.
· Post myocardial infarction -- Start with non-intrinsic sympathomimetic activity
(non-ISA) beta blocker (Metoprolol).
· Peripheral vascular disease -- Start with CCA (Verapamil, Diltiazem)
· Benign prostatic hypertrophy -- Start with alpha blocker (Doxazosin)
· Dyslipidemia -- Alpha agonist (Clonidine), alpha blocker (Doxazosin), ACE
inhibitor or CCA
· Vascular headaches -- Start with beta-blocker (Atenolol, Metoprolol) or CCA
(Verapamil, Diltiazem).
· Asthma or chronic obstructive pulmonary disease (COPD) -- Start with
diuretic; beta-blocker is relative contraindication.
· Hyperuricemia or gout -- Start with beta-blocker; diuretic is relative
contraindication.
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| ssrpk
Forum Fanatic
Topics: 154
Posts: 2,819
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wow, that was trueful helpful....God bless you
good revision 
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| dr_arc
Forum Senior
Topics: 5
Posts: 156
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hey thanks virgola . you are a good soul. this is nice
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| arlete
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Topics: 50
Posts: 3,602
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Niiiice!
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| tongsaa
Forum Junior
Topics: 16
Posts: 55
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one quick question about diuretics for renal insuffiency...
if the renal insufficiency is caused by prerenal azotemia...diuretic shud be used in cautious as overdiuresing may worsened the renal failure
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| khorshid
Forum Guru
Topics: 32
Posts: 592
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Thanks virgola, really important
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