When you have identified a patient requiring pharmacologic hypertension management (ie/meets criteria for stage II hypertension or critical hypertension per AAP 2017 pediatric hypertension guidelines, and/or symptomatic from hypertension), think about the underlying mechanism for hypertension in that patient.
Then, think about the ABCD’s of hypertension:
A: ACE inhibitors (for increased RAAS activation, decreased vascular tone; will decrease GFR and via decreased kidney perfusion by vasconstricting afferent arteriole of the glomerulus)
B: beta blockers (decreases HR –> decreases cardiac output –> decreases BP)
C: calcium channel blockers (e.g. amlodipine, nifedipine; decreases peripheral vascular resistance) typically a safe choice if the underlying mechanism of hypertension is not clear/unknown
D: diuretics (decreases fluid volume to decrease preload)
Residency Rambles 