Page 837 - Cardiac Nursing

LWBK340-c35_p799-822.qxd 29/06/2009 08:59 PM Page 813 Aptara

C HAPTER 35 / Hypertension 813

Table 35-7 ■ COMBINATION DRUGS FOR HYPERTENSION
Combination Type* Fixed-Dose Combination, Mg † Trade Name
ACEIs and CCBs Amlodipine/benazepril hydrochloride (2.5/10, 5/10, 5/20, 10/20) Lotrel
Enalapril maleate/felodipine (5/5) Lexxel
Trandolapril/verapamil (2/180, 1/240, 2/240, 4/240) Tarka
ACEIs and diuretics Benazepril/hydrochlorothiazide (5/6.25, 10/12.5, 20/12.5, 20/25) Lotensin HCT
Captopril/hydrochlorothiazide (25/15, 25/25, 50/15, 50/25) Capozide
Enalapril maleate/hydrochlorothiazide (5/12.5, 10/25) Vaseretic
Fosinopril/hydrochlorothiazide 10/12.5, 20/12.5 Monopril HCT
Lisinopril/hydrochlorothiazide (10/12.5, 15/12.5, 20/25) Zestoretic
Moexipril HCl/hydrochlorothiazide (7.5/12.5, 15/25) Uniretic
Quinapril HCl/hydrochlorothiazide (10/12.5, 20/12.5, 20/25) Accuretic
ARBs and diuretics Candesartan cilexetil/hydrochlorothiazide (16/12.5, 32/12.5) Atacand HCT
Eprosartan mesylate/hydrochlorothiazide (600/12.5, 600/25) Teveten/HCT
Irbesartan/hydrochlorothiazide (150/12.5, 300/12.5) Avalide
Losartan potassium/hydrochlorothiazide (50/12.5, 100/25) Hyzaar
Olmesartan medoxomil/hydrochlorothiazide 20/12.5, 40/12.5, 40/25 Benicar HCT
Telmisartan/hydrochlorothiazide (40/12.5, 80/12.5) Micardis/HCT
Valsartan/hydrochlorothiazide (80/12.5, 160/12.5) Diovan/HCT
ARBs and CCBs Amlodipine/ valsartan (5/160, 10/160, 5/320, 10/320) Exforge
Amlodipine/olmesartan medoxomil (5/20, 10/20, 5/40, and 10/40) Azor
BBs and diuretics Atenolol/chlorthalidone (50/25, 100/25) Tenoretic
Bisoprolol fumarate/hydrochlorothiazide (2.5/6.25, 5/6.25, 10/6.25) Ziac
Propranolol LA/hydrochlorothiazide (40/25, 80/25) Inderide
Metoprolol tartrate/hydrochlorothiazide (50/25, 100/25) Lopressor HCT
Nadolol/bendrofluthiazide (40/5, 80/5) Corzide
Timolol maleate/hydrochlorothiazide (10/25) Timolide
Centrally acting drug and diuretic Methyldopa/hydrochlorothiazide (250/15, 250/25, 500/30, 500/50) Aldoril
Reserpine/chlorthalidone (0.125/25, 0.25/50) Demi-Regroton or Regroton
Reserpine/chlorothiazide (0.125/250, 0.25/500) Diupres
Reserpine/hydrochlorothiazide (0.125/25, 0.125/50) Hydropres
Diuretic and diuretic Amiloride HCl/hydrochlorothiazide (5/50) Moduretic
Spironolactone/hydrochlorothiazide (25/25, 50/50) Aldactone
Triamterene/hydrochlorothiazide (37.5/25, 50/25, 75/50) Dyazide, Maxzide

*Drug abbreviations: ACEI, angiotensin-converting enzyme inhibitor; BB, -blocker; CCB, calcium channel blocker.
† Some drug combinations are available in multiple fixed doses. Each drug dose is reported in milligrams.
From Chobanian, A. V., Bakris, G. L., Black, H. R., et al. (2003). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure: The JNC 7 report. JAMA, 289(19), 2560–2572. (Erratum in JAMA, 2003, 290(2), 197.)

with the incidence in persons older than 70 years being 7%, and the treatment group was compared with the control group,
in persons older than 80 years the incidence was more than there was a significant decrease in stroke. No serious short-term
25%. 190 Analysis of data from the Framingham Study and a 20- side effects occurred as a result of treatment. The Swedish Trial
year follow-up of NHANES I participants revealed that even bor- in Old Patients with Hypertension (STOP Hypertension) stud-
derline systolic HTN was associated with significant morbidity ied a group of 1,627 with systolic and diastolic HTN (mean en-
and mortality. 191,192 In the Framingham Study, persons with bor- try BP 195/102 mm Hg). 199 In the group treated with diuret-
derline isolated SBP had increased risks for all CVD, coronary ics or -blockers, there was a mean decrease in BP of 27/9 mm
heart disease, stroke, transient ischemic attack, heart failure, and Hg, with statistically significant decreases in fatal and nonfatal
mortality from CVD. The hazard ratios for each of these were sig- strokes and congestive heart failure. This study showed the ben-
nificantly greater than 1.0 (range 1.42 to 1.60) after the data had efit of treating older adults patients with systolic and diastolic
been adjusted for sex, decade of age, cholesterol level, BMI, ciga- HTN.
rette smoking, and glucose intolerance. Treatment of the older adults is similar to that of younger pa-
Several large randomized trials have demonstrated the bene- tients. Emphasis can be put on the lifestyle management, includ-
fits of HTN control in the older adults. 193–197 Two meta-analy- ing weight loss, sodium restriction, and exercise, because of the
ses of clinical trials on individuals older than 60 years found multiple benefits to older adults. 200 Physical activity, for example, of-
that treatment reduced the incidence of coronary heart disease fers not only reduction of BP but also weight management, reduced
by between 18% and 19%, stroke by 30% to 34%, and total disability, and decreased mortality. 201,202 The same medications are
mortality by 13%. 72,198 The largest study, the SHEP, had a used in the older adults, but lower initial doses are recommended,
population of 4,736 men and women older than 60 years with and there may be more comorbid conditions that will make one med-
7
a mean baseline BP of 170/70 mm Hg. 196 The goal of this clin- ication a better choice than another. Cost will also be a factor because
ical trial was to determine drug efficacy, side effects, and even- many older adults persons have a limited income. Because the older
tual long-term outcomes related to morbidity and mortality adults have an increased sensitivity to orthostatic hypotension, cau-y y
from CVD. When the 17-mm Hg reduction in mean SBP in tion is required with drugs that may cause dizziness on standing,