Hypertension with Diabetes Hypertension with Pregnancy

Early treatment of hypertension is particularly important in diabetic patients both to prevent cardiovascular disease and to minimize progression of renal disease and diabetic retinopathy

• The ADVANCE trial was designed to evaluate the effect of intensive blood pressure and glycemic control on cardiovascular disease.

Risk Factors Hypertension with Diabetes

• Poor response to therapy:
• Renal disease
• Alcohol or drug use
• Onset in patients of age <20 and >50 years
• Lack of family history of hypertension
• Significant target end organ damage
• In addition to factors listed below, resistant hypertension is more common in the following patients: female, African American race, obese, diabetic
• Worsening of control in previously stable hypertensive patient
• Stage 2 HTN (systolic BP >160 mm Hg or diastolic BP >100 mm Hg)

Hypertension with Diabetes Drugs —

• Ramipril
• Losartan
• Diuretics
• Telmisartan

Other drugs :

• · Enalapril
• · Lisiinopril
• · Fosinopril

Hypertension with heart failure :

• Diuretics – Spironolactone,
• Furosemide
• Nebivolol
• Enalapril
• Ramipril
• Losartan
• Carvedilol

Hypertension with CAD :

Beta blockers –

• Metoprolol,
• atenolol,
• nebivolol,
• Diuretics
• ramipril / lisinopril / Enalapril

Calcium channel blockers –

• diltiazem,
• nifedipine depending on heart rate –

Hypertension with MI :

• Beta blockers
• ACE inhibitors
• Spironolactone

Hypertension with CRF :

• ACE inhibitors ARBs
• Central acting – methyldopa,clonidine
• Beta blockers Nifedipine Diuretics

Hypertension with stroke :

1. Diuretics
2. Perindopril and other ACE Inhibitors Beta blockers
3. Calcium channel blockers

Hypertension with Pregnancy :

• AlphamethyI dopa ,
• Diuretics
• Calcium channel blockers

Other drugs besides antihypertensives which must be prescribed in hypertensives :

• Aspirin (except if the BP is very high)
• Clopidogrel,
• Aspirin
• Antioxidants
• Coronary vasodilators if required

Drugs in hyertensive crises :

• IV NTG (Nitroglycerine) IV Metoprolol
• IV Diltiazem
• IV Nitroprusside
• IV Frusemide, Torsemide IV Aminophylline
• NTG patch
• Isosorbide mononitrate spray- in buccal cavity