DR Medhat MRCP

Stepwise approach of treatment of HTN :
Step 1 o CCB ( if age > 55 years or Afro-Caribbean origin)
سؤال age) o ACE- - ( if age < 55 years or if DM or HF regardless the
Step 2 o CCB + ACE - -
Step 3 o CCB + ACE -- + Thiazide (chlorothalidone or indpamide)
Step 4
(Resistant HTN)
o CCB
+ ACE - - + Thiazide + further diuretic
If K < 4.5 If K > 4.5
Add spironolactone 25 mg OD
Add higher doses of thiazide-like
Diuretics
If diuretics not tolerated or contraindicated or ineffective
α-blocker (Doxazocin) or β-blocker
Drug
intolerance
Direct rennin inhibitor (Aliskiren)[Rasilez]
- Inhibit conversion of angiotensinogen to angiotensin 1.
Blood pressure targets
Clinic BP
ABPM / HBPM
Age < 80 years 140/90 mmHg 135/85 mmHg
Age > 80 years 150/90 mmHg 145/85 mmHg
Types of HTN in pregnancy (> 140/90 mmHg or
> 30/15 above booking reading)
Pre-existing hypertension
- H/O HTN before pregnancy
or HTN before 20 weeks
gestation
- No proteinuria, no oedema
- Occurs in 3-5% of
pregnancies and is more
common in older ♀
Pregnancy-induced HTN
(PIH, also known as gestational HTN)
- HTN occurring in the second half of
pregnancy (i.e. after 20 weeks)
- No proteinuria, no oedema
- Occurs in around 5-7% of pregnancies
- Resolves following birth (typically
after one month).
- Women with PIH are at increased risk
of future pre-eclampsia or HTN later.
Pre-eclampsia
- PIH in association
with proteinuria (>
0.3 g /24h)
- Oedema may occur
less commonly
used as a criteria
- Occurs in around
5% of pregnancies
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