Students in their first graduate level pharmacology course are confused with the recommendations for hypertension (HTN) and treatment choices after ST-elevation myocardial infarction (STEMI) and with heart failure (HF). The drugs used several years ago and still seen commonly on the acute care floors the students work are not the ones now assuming a stronger role in cardiac health issues. For one, the primary order of which meds are selected for an initial level of blood pressure control has seemed to change.
1. Which classification of drugs has taken the first-choice role in most patients with early hypertension? Is it wrong to select a thiazide diuretic or a beta blocker as was once done?
2. Is there another primary choice for African American patients? Why?
Must cite references in APA.
- In recent years, the primary choice of medication for initial blood pressure control in most patients with early hypertension has shifted towards angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs). This shift is based on evidence from clinical trials and guidelines recommending these medications due to their efficacy and favorable cardiovascular outcomes. Thiazide diuretics and beta blockers are still used in certain cases, but ACE inhibitors or ARBs are often preferred as first-line therapy due to their proven benefits in reducing cardiovascular events and mortality rates.
Reference: James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J.,… & Smith Jr, S. C. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA, 311(5), 507-520.
- For African American patients, the primary choice of medication for hypertension management is often a calcium channel blocker (CCB) or a thiazide diuretic. This recommendation is based on clinical trial evidence indicating that African American patients may have a better response to these medication classes compared to ACE inhibitors or beta blockers. Additionally, the higher prevalence of salt sensitivity and low-renin hypertension in African American individuals contributes to the preference for CCBs and thiazide diuretics.
Reference: Flack, J. M., Sica, D. A., Bakris, G., Brown, A. L., Ferdinand, K. C., Grimm Jr, R. H.,… & Nesbitt, S. D. (2010). Management of high blood pressure in Blacks: an update of the International Society on Hypertension in Blacks consensus statement. Hypertension, 56(5), 780-800.