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Up date on hypertension Doc. dr Amra Maci - Dankovi

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Treatment of hypertension in DM type 2 patients Two or more drugs/combination therapy are usually needed to reach the target BP (below 140/90mmHg, but not below 120mmHg) It has been proven that : ACE inhibitors cardiovascular protective and ARB nephroprotective Blocade of the renin-angiotensin system seems to be an appropriate choice even though there is no concensus on the drug of choice for all patients

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Hypertension in pregnancy An important risk factor of hypertension and stroke in later adult life of women Starting treatment/ 140/90mmHg in women with gestational hypertension, subclinical organ damage or symptoms and 150/95mmHg in other circumstances The drugs od choice: methyldopa, labetalol, calcium antagonists (proven efficiency), - blokers. Strictly contraindicated: ACEi, angiotensin II antagonists and RI, diuretic therapy (in pre-eclampsia) BP >170/110 mmHg considered as an emergency and treated hospitaly with i.v. labetalol or p.o. methyldopa (hydralazine is no longer the drug of choice!) Bromocriptin may induce hypertension Antihypertensive drugs are present in very low concentrations in breast-milk,except propranolol and nifedipine which conc are similar in maternal plasma

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Hypertension in chronic renal failure A target BP is 1g/24h. The most frequent combination is ACEI, ARB or RI with diuretics; a calcium antagonist or a blocker can be added. blocker should be used carefully in type 1 diabetic patients and avoided in patients with severe peripheral vascular disease! If GFR

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Isolated systolic hypertension Lifestyle modifications,target systolic BP is