high blood pressure 18

The lowering of even moderately elevated hypertension is shown to significantly reduce http://www.onhealth.com/high_blood_pressure/article.htm cardiovascular mortality and morbidity. Monitor hypertension when beginning an antihypertensive drug and through titration, and periodically after desired hypertension is achieved. NON-PHARMACOLOGIC INTERVENTIONS:

Advise all patients to prevent smoking, shed extra pounds, restrict dietary unhealthy fat and salt intake, limit alcohol, and fitness appropriately. Avoid estrogen-containing oral contraceptives; a progestin-only pill might be preferable. Such changes in lifestyle needs to be continued even if blood pressure remains elevated and drug therapy is initiated. PHARMACOLOGIC INTERVENTIONS: See charts in this particular section. Doses of most drugs ought to be individualized. Visit www.eMPR.com for a whole list of antihypertensive medications. ACCUPRIL Pfizer Rx ACE inhibitor. Quinapril (as HCl) 5mg10mg, and 20mg 40mg; tabs; scored. Indications: Hypertension.

Adults: Monotherapy: Once daily initially 10-20mg. Usual maintenance: 20-80mg daily in 1-2 divided doses. Elderly: Once daily initially 10mg. Patients on diuretic: Before you start; resume diuretic if BP not controlled by quinapril alone, suspend diuretic for a couple of-3 days. If diuretic cannot be discontinued, or maybe creatinine clearance (CrCl) 30-60mL/min: initially 5mg daily. CrCl 1030mL/min: initially 2.5mg daily. Children: Not advised. Contraindications: Reputation of ACEI-associated or some other angioedema. Pregnancy (Cat.D in 2nd and 3rd trimesters). Warnings/Precautions: Salt/volume depletion. Renal or hepatic impairment. CHF. Dialysis (esp. highflux membrane). Monitor renal function in severe CHF, hypertension, or renal artery stenosis. Monitor WBCs in renal or collagen vascular disease. Monitor for hyperkalemia in diabetics. Surgery. Discontinue if angioedema, laryngeal edema, jaundice or high blood pressure symptoms marked elevation in liver enzymes occurs. Pregnancy (Cat.C in 1st trimester). Nursing mothers. Interactions: [K.sup. ] supplements, [K.sup. ] sparing diuretics, [K.sup. ] containing salt substitutes could cause hyperkalemia. May increase lithium levels. Antagonizes tetracycline. Potentiated by diuretics. Nitritoid reactions with concomitant injectable gold (eg, sodium aurothiomalate); rare. Negative effects: Headache, fatigue, dizziness and cough GI upset, hyperkalemia, back problems, tachycardia, dry mouth, somnolence, sweating, sinusitis. How supplied: Tabs--90 ACEON Solvay Rx ACE inhibitor. Perindopril erbumine4mg and 2mg, 8mg; scored tabs. Indications: Hypertension. Adults: Or even on diuretic: Once daily or even in 2 divided doses initially 4mg. Titrate; max 16mg/day. Usual maintenance 4-8mg once daily. If on diuretic: If you can, 2-72 hours before starting therapy, suspend diuretic. If diuretic cannot be discontinued (monitor closely): initially 2-4mg once daily or maybe in 2 divided doses; max 16mg/day. Renal impairment: CrCl <30mL/min: not recommended; CrCl>30mL/min: initially high blood pressure symptoms 2mg/day: max 8mg/day. Children: Not suggested. Elderly: >65 yrs: usual max 8mg/day. Contraindications: Background of ACEI-associated or any other angioedema. Pregnancy (Cat.D in 3rd and 2nd trimesters). Warnings/Precautions: Renal or hepatic impairment. Salt/volume depletion. Severe CHF. Renal artery or aortic stenosis. Monitor for neutropenia in renal or collagen vascular disease. Monitor for hyperkalemia in diabetics. Dialysis. Surgery. Discontinue if laryngeal edema, angioedema, marked elevations of liver enzymes or jaundice occurs. Black patients could have greater risk of angioedema than non-black patients. Elderly. Pregnancy (Cat.C in 1st trimester). Nursing mothers.

Interactions: Excessive hypotension with diuretics. Hyperkalemia with [K.sup. ] supplements, [K.sup. ] sparing diuretics, [K.sup. ] containing salt substitutes, others (eg, cyclosporine, indomethacin, heparin). May increase lithium levels. Caution with gentamicin, digoxin. Adverse reactions: Headache, sinusitis, dizziness and cough viral infection, hypertonia, upper extremity pain, proteinuria, dyspepsia and fever palpitations.