Anisyah Achmad, S.Si., Apt.

, Sp,FRS
Department of Clinical Pharmacy,
Major of Pharmacy, FKIK- UNSOED
 Compelling Indications
1. LVH : Diuretic + ACE-I then add Beta
Blocker
If not covered so plus Aldasteron antagobis
or ARB

2. PMI : Beta Blocker then add ACE-I or

ARB

3. CAD : Beta Blocker then add ACE-I or

ARB
If not covered so plus CCB and diuretic
 Continue

4. Diabetes : ACE-I or ARB

If not covered so plus CCB and Beta
blocker

5. CKD : ACE-I or ARB

6. Recurrent Stroke : Diuretic with ACE-I

Considerations with specific antihypertension

1. Beta Blocker
a. Astma,
b. COPD,
c. increased risk of developed DM
compared with ACE-I, ARB, CCB so
precaution in Px. High risk DM,
d. may cause depression
 Continue
2. Thiazides
a. Increasing serum uric acid
b. increased risk of developed DM
compared with ACE-I, ARB, CCB so
precaution in Px. High risk DM,
c. May assist in management of OP by
preventing urine calcium loss
 Continue
3. ACE-I and ARB
a. Contraindicated in pregnancy
b. Contraindicated with bilateral renal artery
stenosis
c. Monitoring Kalium loss
d. Monitoring for diabetic nephropathy :
depend on Px
 Continue
4. Aliskiren
a. A direct rennin antagonist
b. With combine Losartan in Ht, Dm
and Nephropathy Px..showed
renoprotective effect independently of
BP effect
c. Combination with ACE-I or ARB is
superior.unknown
 Continue
5. Elderly Px.
Caution with antihypertensive agents and
orthostatic hypotension
Initiate with low dose and titrate slowly

6. African American Px.

ACE-I and Beta Blocker generally less
effective
Combination therapy Thiazides improve
effectiveness
 Continue
7. Pregnancy
Methyldopa and hidralazine are recommended
Most therapy ( except. ACE-I and ARB) can be
safety

8. Monitoring
Return in 4 weeks to assess efficacy
If no adequate respon so changed with a drug from
a different class
 CASE-STUDY
1. Give treatment of HT first line of durg class for each
Px viggenettes below :
A 55 year old white woman discharged after a CA, Bp =
158/ 92 mm/hg, HR= 80 beats/ minute
Anisyah Achmad, S.Si., Apt., Sp,FRS
Department of Clinical Pharmacy,
Major of Pharmacy, FKIK- UNSOED
 Compelling Indications
1. LVH : Diuretic + ACE-I then add Beta
Blocker
If not covered so plus Aldasteron antagobis
or ARB

2. PMI : Beta Blocker then add ACE-I or

ARB

3. CAD : Beta Blocker then add ACE-I or

ARB
If not covered so plus CCB and diuretic
 Continue

4. Diabetes : ACE-I or ARB

If not covered so plus CCB and Beta
blocker

5. CKD : ACE-I or ARB

6. Recurrent Stroke : Diuretic with ACE-I

Considerations with specific antihypertension

1. Beta Blocker
a. Astma,
b. COPD,
c. increased risk of developed DM
compared with ACE-I, ARB, CCB so
precaution in Px. High risk DM,
d. may cause depression
 Continue
2. Thiazides
a. Increasing serum uric acid
b. increased risk of developed DM
compared with ACE-I, ARB, CCB so
precaution in Px. High risk DM,
c. May assist in management of OP by
preventing urine calcium loss
 Continue
3. ACE-I and ARB
a. Contraindicated in pregnancy
b. Contraindicated with bilateral renal artery
stenosis
c. Monitoring Kalium loss
d. Monitoring for diabetic nephropathy :
depend on Px
 Continue
4. Aliskiren
a. A direct rennin antagonist
b. With combine Losartan in Ht, Dm
and Nephropathy Px..showed
renoprotective effect independently of
BP effect
c. Combination with ACE-I or ARB is
superior.unknown
 Continue
5. Elderly Px.
Caution with antihypertensive agents and
orthostatic hypotension
Initiate with low dose and titrate slowly

6. African American Px.

ACE-I and Beta Blocker generally less
effective
Combination therapy Thiazides improve
effectiveness
 Continue
7. Pregnancy
Methyldopa and hidralazine are recommended
Most therapy ( except. ACE-I and ARB) can be
safety

8. Monitoring
Return in 4 weeks to assess efficacy
If no adequate respon so changed with a drug from
a different class
 CASE-STUDY
1. Give treatment of HT first line of
durg class for each Px viggenettes
below :
A 55 year old white woman discharged
after a CA, Bp = 158/ 92 mm/hg, HR=
80 beats/ minute
 CASE-STUDY
2.Give treatment of HT first line of durg
class for each Px viggenettes below :
A 32 year old, African American man
with no comorbid conditions, BP= 150/
88 mm Hg, Hr= 80 beats/mnt
 CASE-STUDY
3. A 45 years old white man ( 100 kg) , has 30 pack/
year history of tobacco use and doesnt drink
alcohol. His vital BP 138/82 mm Hg, Hr = 74
beats/mnt. His laboratory Na= 144 mEq/L, K= 4,2
mEq/L, BUN= 12 mg/dl, SCr = 1,0 mg/L, Fasting
Lipis total cholesterol 239 mg/dL, HDL = 50 mg/dl
and Tg = 140 mg/dL

Question : Please give a initially drugs for this

patient
THANK YOU