The patient has Joint National Committee stage 1 hyperten-sion (see Table 11–1). The first question in management is how urgent is it to treat the hypertension. Cardiovascular risk factors in this man include family history of early coro-nary disease and elevated cholesterol. Evidence of end-organ impact includes left ventricular enlargement on electro-cardiogram. The strong family history suggests that this patient has essential hypertension. However, the patient should undergo the usual screening tests including renal func-tion, thyroid function, and serum electrolyte measurements. An echocardiogram should also be considered to determine whether the patient has left ventricular hypertrophy secondary to valvular or other structural heart disease as opposed to hypertension. Initial management in this patient can be behavioral, including dietary changes and aerobic exercise. However, most patients like this will require medication. Thiazide diuretics in low doses are inexpensive, have relatively few side effects, and are effective in many patients with mild hypertension. Other first-line agents include angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers. Beta blockers might be considered if the patient had coronary disease or had labile hypertension. A single agent should be prescribed and the patient reassessed in a month. If a second agent is needed, one of the two agents should be a thiazide diuretic. Once blood pressure is controlled, patients should be followed periodically to reinforce the need for compliance with both lifestyle changes and medications.
Bisoprolol Generic,Zebeta
Esmolol Generic,Brevibloc
Metoprolol Generic,Lopressor,Toprol-XL
Nadolol Generic, Corgard
VASODILATORS USED IN HYPERTENSION Diazoxide Hyperstat IV, Proglycem (oral for insulinoma)
Penbutolol Levatol Fenoldopam Corlopam Propranolol Generic, Inderal, Inderal LA
Hydralazine Generic,Apresoline
Pindolol Generic,Visken
Minoxidil Generic, Loniten
Nitroprusside Generic, Nitropress
Clonidine Generic, Catapres, Catapres-TTS
GuanabenzGeneric,Wytensin
Guanfacine Generic, Tenex
Felodipine Generic, Plendil
Diltiazem Generic,Cardizem,Cardizem CD, Cardizem SR, Dilacor XL
Isradipine Generic,DynaCirc,Dynacirc CR
Nicardipine Generic, Cardene, Cardene SR, Reserpine Generic
Captopril Generic,Capoten
Fosinopril Generic,Monopril
Moexipril Generic,Univasc
Quinapril Generic,Accupril
Candesartan Generic,Atacand
Irbesartan Generic,Avapro
Treatment of Angina Pectoris
Bertram G. Katzung, MD, PhD*
A 56-year-old woman presents in the office with a history of recent-onset chest discomfort when jogging or swimming vigorously. The pain is dull but poorly localized; it disap-pears after 5–10 minutes of rest. She has never smoked but has a history of hyperlipidemia (total cholesterol level of 245 mg/dL and low-density lipoprotein [LDL] of 160 mg/dL recorded 1 year ago) and admits that she has not been fol-lowing the recommended diet. Her father survived a “heart attack” at age 55, and an uncle died of some cardiac disease at age 60. On physical examination, the patient’s blood pressure is 145/90 mm Hg, and her heart rate is 80 bpm. She is in no acute distress, and there are no other significant physical findings; an electrocardiogram is normal except for slight left ventricular hypertrophy. Assuming that a diagno-sis of stable effort angina is correct, what medical treatment should be implemented?