This document provides counseling information for patients taking medications to treat hypertension. It discusses several classes of blood pressure medications including ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, thiazide diuretics, and clonidine. Key points covered include the importance of continuing treatment even if feeling well, potential side effects to watch out for, drug interactions to be aware of, and guidelines for proper use of specific medications.

1. Hypertension
Patient Counseling

2. All Hypertension Medications
 You may not feel that you have high blood pressure, as often there are
no obvious symptoms.
 It is important that you continue using this medication, even if you feel well.
 You may need to use blood pressure medication for the rest of your life to
prevent serious complications, such as kidney damage, stroke and heart attack.
 If you miss a dose, take the missed dose as soon as you remember.
 If it is almost time for your next dose, skip the missed dose and take the
medication at the next regularly scheduled time.

3.  Do not take extra medication to make up the missed dose.
 To be sure this medication is helping your condition, your blood pressure
will need to be checked on a regular basis.
 You may have been instructed to check your blood pressure at home.
 Record the measurements in a notebook and bring them to your appointments for
your provider to see.
 This medication is only one part of a complete treatment program for your high blood
pressure; it is important that you follow the recommended diet, exercise and weight
control plans closely.

4. Thiazide Diuretics
 Members:
(Chlorothiazide, Chlorthalidone, Hydrochlorothiazide, Indapamide, Metolazone )
 This medication will cause you to urinate more throughout the day.
 If you need to take the medication twice daily, be sure to take your second dose
no later than 4 P.M. to avoid getting up at night to go to the bathroom.
 This medication can make you feel dizzy and lightheaded when getting up from
a sitting or lying position.
 Get up slowly. Let your feet hang over the bed for a few minutes before getting up.
 Hang on to the bed or nearby dresser when standing from a sitting position.

5.  This medication can decrease the amount of potassium in your body.
 Potassium supplements may be needed while you are on this medication to ensure
you have enough potassium for your heart.
 If you have diabetes, your blood sugar may need to be monitored more frequently
when you start this medication as it can affect increase your blood sugar.
 Avoid drugs that can cause sodium and water retention (e.g., NSAIDs), as
they can decrease the effectiveness of antihypertensive medications.
* Chlorothiazide is the only medication in this class available IV .

7. Calcium Channel Blockers (CCBs)
 There are two types of CCBs:
Dihvdropyridines (DHP) and Non-dihydropyridines (Non-DHP).
 DHPs : are Amlodipine, Felodipine, Isradipine, Nifedipine, Nisoldipine, Nicardipine and Clevidipine
 Non-DHP : Diltiazem and Verapamil
 Diltiazem and Verapamil are substrates of P-gp and moderate inhibitors of CYP3A4.
 They can increase the concentration of many other drugs.
 Patients who take statins should use lower doses of simvastatin or lovastatin or
use a statin that is not metabolized by CYP3A4 (e.g. , Pitavastatin, Pravastatin,
Rosuvastatin) .

8.  This medication can cause a few side effects, including swelling of the ankles,
feeling tired, dizziness, headache, a hot or warm feeling in your face and
palpitations.
 Other medications can alter how this drug works.
 Do not start any new medications, including over-the counter drugs or
supplements, unless you check with your healthcare provider first.
 Avoid eating grapefruit or drinking grapefruit juice while using this
medication.
Nifedipine ER : should be taken on an empty stomach.
Nifedipine ER : this medication can leave an empty shell in your stool.
 If you see the tablet in your stool, it is nothing to worry about.

14. ACE Inhibitors, ARBS And Aliskiren
 ACE inhibitors end in "-pril" .
 Members:
Benazepril, Captopril, Enalapril, Enalaprilat (Vasotec IV), Fosinopril, Lisinopril,
Moexipril, Perindopril, Quinapril, Ramipril, Trandolapril
 ARBs end in "-sartan”.
 Members:
Azilsartan, Candesartan, Eprosartan, Irbesartan, Losartan, Olmesartan,
Telmisartan, Valsartan
 Direct Renin Inhibitor: Aliskiren (Tekturna)

15. ACE Inhibitors, ARBS And Aliskiren
 This medication can cause birth defects if taken during pregnancy.
 Use an effective form of birth control while taking this medication.
 If you become pregnant during treatment, stop using this medication
and tell your healthcare provider right away.
 This medication can increase the amount of potassium in your body.
 Do not use salt substitutes or potassium supplements while taking this
medication, unless your healthcare provider has told you to do so.
 Get emergency medical help if you have any of these signs of an allergic
reaction: hives, difficulty breathing, or swelling of your face, lips, tongue,
and/or throat.
 ACE inhibitors: tell your healthcare provider if you develop a dry, hacking
cough that is bothersome while taking this medication.
 ACE inhibitors and ARBs should not be used in combination with
Entresto (Sacubitril/Valsartan). If switching from an ACE inhibitor
to Entresto, or vice versa, a 36 hour washout period is required.

24. Beta-blockers
 Beta-blockers mostly end in "-olol."
 For most conditions, any beta-blocker can be selected, but Bisoprolol,
Carvedilol or Metoprolol Succinate should be used if treating chronic
heart failure.
Members:
 Beta-1 Selective Blockers: Acebutolol, Atenolol ,Betaxolol, Bisoprolol,
Esmolol, Metoprolol.
 Beta-1 Selective Blocker with Nitric Oxide-Dependent Vasodilation: Nebivolol
 Beta-1 and Beta-2 Blockers (Non-Selective) : Nadolol, Pindolol , Propranolol,
Timolol.
 Non-Selective Beta-Blocker and Alpha-1 Blockers : Carvedilol, Labetalol.

25.  Take this medication at the same time every day.
 Do not abruptly discontinue your medication without consulting your
healthcare provider as stopping suddenly can make your condition worse.
 This medication can cause a few side effects, including dizziness, fatigue, and
rarely, sexual problems.
 If these side effects bother you, let your healthcare provider know.
 If you have diabetes, this medication can cause you to miss some of the
symptoms of low blood sugar (e.g., shakiness, palpitations, anxiety).
 You will still experience sweating and hunger if your blood sugar is low.
 Non-selective beta-blockers: contact your healthcare provider if you
experience any difficulty breathing while taking this medication.
 Carvedilol : take this medication with food.
 Metoprolol tartrate or Metoprolol succinate : take with or immediately after meals.

29. Clonidine
is commonly used for resistant hypertension.

30. Clonidine
 Do not stop clonidine suddenly; this can cause your blood pressure
to become dangerously high.
 Make sure you do not run out of medication.
 Clonidine can cause a variety of side effects, including drowsiness,
dizziness, fatigue, dry mouth, depression and sexual dysfunction.
 If the side effects bother you, let your healthcare provider know but do not
stop taking this medication suddenly.
 Apply the clonidine patch (Catapres-TTS ) weekly to a hairless area of the skin
on the upper outer arm or chest.
 Change the patch every seven days. The white adhesive cover can be
applied over the patch to keep it in place.
 Do not place the patch on broken or irritated skin.
 After seven days, remove the used patch and apply a new patch to a
different area than the previous site to avoid skin irritation.
 When removing the patch, be sure to discard it safely, away from the reach of
any children or pets.
 The patch will need to be removed before an MRI to prevent a potential burn.

31. Thank you