Joint National Committee 8 recommends initial therapies of a thiazide diuretic or CCB in black patients, but does not provide specific guidance on the best second agent to choose. In general, it recommends adding a CCB, thiazide diuretic, ACE-I, or ARB as a second drug if a patient is not responding to monotherapy.
Full Answer
What is the best second agent for black patients with thiazide diuretic?
Joint National Committee 8 recommends initial therapies of a thiazide diuretic or CCB in black patients, but does not provide specific guidance on the best second agent to choose. In general, it recommends adding a CCB, thiazide diuretic, ACE-I, or ARB as a second drug if a patient is not responding to monotherapy.
What should I know about thiazide diuretics before taking them?
People who have diabetes may have increased blood sugar levels when taking thiazide diuretics. It is not recommended to use thiazide diuretics with dofetilide ( Tikosyn ), a drug used for treating abnormal heart rhythms, as this may increase the blood levels of dofetilide (Tikosyn) and cause abnormal heart rhythms.
Do we need a thiazide diuretic to augment monotherapy for chronic bronchitis?
The current data suggest that CCB monotherapy may also need to be augmented by a thiazide diuretic.
Do diuretics work in black patients?
Despite the reported efficacy for use of thiazide diuretics and potassium-sparing diuretics in blacks, a recent study of treated black patients in an ambulatory clinic found that only 39% of patients reported taking a diuretic.
What is the best high blood pressure medicine for black patients?
Experts recommend Black adults start with either a thiazide diuretic — such as chlorthalidone or hydrochlorothiazide — or a calcium channel blocker like amlodipine (Norvasc).
Which drug class is recommended as first line treatment for an African American patient with hypertension?
In the text of the guideline, mentions that diuretics should be the agent of first choice for blacks with hypertension because of their proven effectiveness in clinical trials. For whites, beta-blockers are also an option for first line therapy. Mono-therapy with beta-blockers or ACE-Is is less effective in blacks.
Can thiazide diuretics cause dizziness?
Side effects If you take a thiazide diuretic, your potassium level can drop too low (hypokalemia), which can cause life-threatening problems with your heartbeat. If you're on a potassium-sparing diuretic, you can have too much potassium in your blood. Other possible side effects of diuretics include: Dizziness.
What is the antidote for hydrochlorothiazide?
There is no specific antidote. Reversible acute renal failure following ingestion of 50 tablets of a product containing a combination of 50 mg triamterene and 25 mg hydrochlorothiazide has been reported.
Why are ACE-I and ARBs not recommended for African black population?
It is commonly reported that the blood pressure lowering efficacy of renin angiotensin system (RAS) inhibitors is attenuated in African Americans due to a greater likelihood of having a low renin profile. Therefore these agents are often not recommended as initial therapy in African Americans with hypertension.
Are ACE inhibitors safe for African American?
African Americans are also at greater risk for cardiovascular events than whites. “The results of this study adds to a growing consensus among physicians that treatment of hypertension in blacks should not be initiated with ACE inhibitors,” said Dr.
Should I take potassium with hydrochlorothiazide?
If you take a low dose of chlorthalidone or hydrochlorothiazide and have normal kidney function, your doctor will probably recommend getting potassium from dietary sources. You can boost your potassium intake from the same foods that are heart healthy – vegetables, fruits and fish.
Which supplementation is necessary with thiazide diuretic to reduce adverse effects?
Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side effects of thiazides.
What is spironolactone used for?
Spironolactone is used in combination with other medicines to treat high blood pressure (hypertension) and heart failure. Lowering blood pressure can reduce the risk of strokes and heart attacks. Spironolactone is also used to lessen the need for hospitalization for heart failure.
What is the antidote for diuretics?
Fludrocortisone is used as a third-line agent in patients for whom treatment with diuretics, sodium bicarbonate, and dietary measures has failed. It promotes increased reabsorption of sodium and loss of potassium from renal distal tubules.
Which is better lisinopril or hydrochlorothiazide?
The results indicate slight superiority of lisinopril over hydrochlorothiazide with regard to control of diastolic blood pressure with a better effect on overall electrolyte balance.
When administering hydrochlorothiazide which labs must be monitored?
Lab Test Considerations: Monitor electrolytes (especially potassium), blood glucose, BUN, and serum uric acid levels before and periodically throughout course of therapy.
What is thiazide diuretics?
Summary. Thiazide diuretics are drugs prescribed to treat high blood pressure and reduce edema (fluid accumulation) in the body. Side effects, drug interactions, dosage, and storage information should be reviewed before taking this medication.
What is a thiazide pill?
Thiazide diuretics (water pills) are medications that are used to treat high blood pressure ( hypertension) and reduce fluid accumulation in the body. They work by reducing the ability of the kidneys to reabsorb salt and water from the urine and into the body thereby increasing the production and output of urine (diuresis).
Does thiazide cause lithium?
Thiazide diuretics can increase the risk of lithium (Eskalith, Lithobid) toxicity by reducing the kidney's ability to eliminate lithium in the urine. Drugs known as nonsteroidal anti-inflammatory drugs ( NSAIDs) such as ibuprofen ( Motrin ), naproxen ( Naprosyn ), and nabumetone (Relafen) can reduce the effectiveness ...
Does thiazide lower potassium?
Thiazide diuretics can lower potassium and magnesium blood levels since they are both eliminated in urine. Low levels of potassium and magnesium in the blood can result in abnormal heart rhythms, particularly in those who are also taking digoxin ( Lanoxin) in addition to a thiazide.
Can thiazide cause uric acid?
Owing to their ability to increase the production of urine, these drugs may lower levels in the body of potassium and magnesium which also are present in urine. Thiazide diuretics may increase uric acid levels in blood. Like other antihypertensive medications, thiazides cause sexual dysfunction.
Can you take thiazide with dofetilide?
It is not recommended to use thiazide diuretics with dofetilide ( Tikosyn ), a drug used for treating abnormal heart rhythms, as this may increase the blood levels of dofetilide (Tikosyn) and cause abnormal heart rhythms.
What is the best treatment for black people with hypertension?
The American College of Cardiology and American Heart Association 2017 hypertension guidelines suggest initial therapy of a calcium channel blocker (CCB) or thiazide diuretic for black patients. Further, it states that two drugs are often needed for treatment of hypertension in black patients.
What is the best medication for black patients?
The American Society of Hypertension and the International Society of Hypertension recommends a CCB or thiazide diuretic (CCB preferred, but thiazide diuretic if cost is a concern) as initial drugs of choice for black patients. If additional treatment is indicated, they suggest adding an ACE-I or ARB.
Do black people have hypertension?
Background: Black patients have a higher prevalence of hypertension, treatment resistant hypertension, and poorer blood pressure control. It is known that certain antihypertensive agents work better and have different adverse drug event frequencies in black patient populations, which guides monotherapy. However, various guidelines provide different ...
How common is high blood pressure in Black adults?
High blood pressure is much more common in Black people as compared to other groups in the U.S. It affects 56% of Black adults in the U.S. as compared to 48% of white adults, 46% of Asian adults, and 39% of Hispanic adults.
Why is high blood pressure more common and more severe in Black people?
There’s no definitive answer for why high blood pressure is more common and more severe in Black people. Some theories have looked at genetic and environmental factors as possible causes, but it isn’t very well understood.
How is high blood pressure treated?
There are treatment plans that don’t require medication and some that do. The approach to treating high blood pressure depends on how severe it is. A healthy lifestyle can help keep hypertension in check. In fact, it’s recommended you make lifestyle modifications to help lower your blood pressure even if your provider prescribes medication for you.
Non-medication treatments for high blood pressure
For elevated blood pressure (systolic 120 to 129 mmHg and diastolic under 80 mmHg) or stage 1 hypertension (systolic 130 to 139 mmHg or diastolic 80 to 89 mmHg), non-medication management is recommended. This would include diet, exercise, and lifestyle changes.
Medication treatment options for high blood pressure
When high blood pressure persists or has advanced to stage 2 (systolic at least 140 mmHg or diastolic at least 90 mmHg), medication is recommended as additional treatment.
Is high blood pressure treated differently in Black adults?
In general, there are a few types of medications that are considered first-choices treatments for high blood pressure. These include thiazide diuretics (a type of “water pill”), ACE inhibitors, ARBs, and calcium channel blockers. For the most part, these medications are equally effective in lowering blood pressure.
Why are ACE inhibitors and ARBs sometimes not recommended for Black adults?
The simple answer is that these medications tend to not work as well in Black people. The reason for this boils down to the way ACE inhibitors and ARBs work.