The lowering of even moderately elevated blood pressure can significantly reduce cardiovascular morb...

1. high blood pressure 14
The lowering of even moderately elevated blood pressure can significantly reduce cardiovascular
morbidity and mortality. Monitor blood pressure levels when beginning an antihypertensive drug
and through titration, and periodically after desired hypertension is achieved.
NON-PHARMACOLOGIC INTERVENTIONS:
Advise all patients to prevent smoking, shed extra pounds, restrict dietary saturated fats and salt
intake, limit alcohol, and fitness appropriately. Avoid estrogen-containing oral contraceptives; a
progestin-only pill could be preferable. If blood pressure levels remains elevated and drug treatment
is initiated, such lifestyle changes should be continued even.
PHARMACOLOGIC INTERVENTIONS:
See charts in this section. Doses of high blood pressure symptoms most drugs should be
individualized.
Visit www.eMPR.com for a whole http://dictionary.reference.com/browse/blood+pressure selection
of antihypertensive medications.
ACCUPRIL Pfizer Rx
ACE inhibitor. Quinapril (as HCI) 5mg20mg, 10mg and 40mg; tabs; scored.
Indications: Hypertension.
Adults: Monotherapy: Once daily initially 10-20mg. Usual maintenance: 20-80mg daily in 1-2 divided
doses. Elderly: initially 10mg once daily. Patients on diuretic: suspend diuretic for 2-three days
before starting; resume diuretic if BP not controlled by quinapril alone. If diuretic should not be
discontinued, or maybe creatinine clearance (CrCI) 30-60mL/min: initially 5mg daily. CrCI 10-
30mL/min: initially 2.5mg dally.
Children: Not recommended.

2. Contraindications: History of ACEI-associated or some other angioedema. Pregnancy (Cat.D in 3rd
and 2nd trimesters).
Precautions: Salt/volume depletion. Renal or hepatic impairment. CHF. Dialysis (esp. high-flux
membrane). Monitor renal function in severe CHF, hypertension, or renal artery stenosis. Monitor
WBCs In renal or collagen vascular disease. Monitor for hyperkalemia in diabetics. Surgery.
Discontinue if angioedema or laryngeal edema occurs. Pregnancy (Cat.C in 1st trimester). Nursing
mothers.
Interactions: [K.sup. ] supplements, [K.sup. ] sparing diuretics, [K.sup. ] containing salt substitutes
could cause hyperkalemia. May increase lithium levels. Antagonizes tetracycline. Potentiated by
diuretics.

3. Negative effects: cough, Headache, fatigue and dizziness GI upset, hyperkalemia, back discomfort,
tachycardia, dry mouth, somnolence, sweating, sinusitis.
How supplied: Tabs-90
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tor. Perindopril erbumine2mg and 4mg, 8mg; scored tabs.
Indications: Hypertension.
Adults: Otherwise on diuretic: Once daily or even in 2
divided doses initially 4mg. Titrate; max 16mg/day.
Once dally Usual maintenance 4-8mg. If on diuretic:
suspend diuretic, if you can, 2-72 hours before
beginning therapy. If diuretic can not be discontinued
(monitor closely): Once daily or in 2 divided doses; max
16mg/day initially 2-4mg. Renal impairment: CrCI
<30mL/min: not recommended; CrCI>30mL/min:
initially 2mg/day: max 8mg/day.
Children: Not recommended.
Elderly: >65 yrs: usual max 8mg/day.
Contraindications: Past of ACEI-associated or another angioedema. Pregnancy (Cat.D In 3rd and 2nd

4. trimesters).
Precautions: Renal or hepatic Impairment. Salt/volume depletion. Severe CHF. Renal artery or aortic
stenosis. Monitor for neutropenia in renal or collagen vascular disease. Monitor for hyperkalemia in
diabetics. Dialysis. Surgery. Discontinue if laryngeal edema, angioedema, marked elevations of liver
enzymes or jaundice occurs. Black patients may have higher risk of angioedema than non-black
patients. Elderly. Pregnancy (Cat.C in 1st trimester). Nursing mothers.
Interactions: Excessive hypotension with diuretics. Hyperkalemia with [K.sup. ] supplements, [K.sup.
] sparing diuretics, [K.sup. ] containing salt substitutes, others (eg, cyclosporine, indomethacin,
heparin). May increase lithium levels. Caution with gentamicin, digoxin