Let's dive into some hypertension (HTN) medication combos' discussion! 👨⚕️🚨
Most HTN pts need ≥ 2 meds for BP goals 🎯. Comorbidities often guide med combos. Eg, post-MI pts might get ACEI/ARB + BB. Avoid BP med adjustments for asymptomatic BP spikes in-hospital 🏥.
- Focus on first-line BP 💊 med combos → ACEI/ARB, CCB, thiazide for CV risk ↓. Opt for moderate doses of combo meds > high dose single med to limit side effects.
- Prefer combos: ACEI/ARB + CCB or ACEI/ARB + thiazide to counter side effects. For example, ACEI/ARB can ↓CCB-induced edema.
- Choose ARB > ACEI for fewer adverse effects like cough or angioedema 🙅♂️. Generic single-pill combos can ↑adherence 🔄.
- If needed, consider a 3-med mix from first-line options.
- For resistant or intolerant cases, NEXT steps: consider spironolactone for hypokalemia, BB (metoprolol, etc) for migraine, or alpha-blocker (doxazosin, etc) for BPH 💡.
- Keep vasodilators (hydralazine,etc) or alpha-2 agonists (clonidine, etc) as last resort due to adherence/side effects.
- ❌ Avoid combos: ACEI + ARB or aliskiren due to increased risks without CV benefit 🚫. OK to mix a dihydropyridine CCB ✅ with a NONdihydropyridine CCB in CKD with resistant HTN, if needed.
- 🔍 Always consider pt's specific needs & comorbidities when choosing HTN meds 🧐.
References
- Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):e127-e248.
- Qaseem A, Wilt TJ, Rich R, et al. Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2017;166(6):430-437.
