I. Initial Diagnostic Evaluation of Hypertension
A. 15 Lead electrocardiography may documentevidence of ischemic heart disease, rhythm and
conduction disturbances, or left ventricular hypertrophy.
B. Screening labs include a complete blood count,
glucose, potassium, calcium, creatinine, BUN, uric
acid, and fasting lipid panel.
C. Urinalysis. Dipstick testing should include glucose,
protein, and hemoglobin.
D. Selected patients may require plasma renin activity,
24 hour urine catecholamines, or renal function
testing (glomerular filtration rate and blood flow).
II. Antihypertensive Drugs
A. Thiazide Diuretics1. Hydrochlorothiazide (HCTZ, HydroDiuril),12.5-25 mg qd [25 mg].
2. Chlorothiazide (Diuril) 250 mg qd [250, 500mg].
3. Thiazide/Potassium Sparing Diuretic Combinations
a. Maxzide (hydrochlorothiazide 50/triamterene75 mg) 1 tab qd.
b. Moduretic (hydrochlorothiazide 50mg/amiloride 5 mg) 1 tab qd.
c. Dya z ide (hydrochlor o t h iazide 25
mg/triamterene 37.5) 1 cap qd.
B. Beta-Adrenergic Blockers
1. Cardioselective Beta-Blockers
a. Atenolol (Tenormin) initial dose 50 mg qd,
then 50-100 mg qd, max 200 mg/d [25, 50,100 mg].
b. Metoprolol XL (Toprol XL) 100-200 mg qd[50, 100, 200 mg tab ER].
c. Bisoprolol (Zebeta) 2.5-10 mg qd; max 20mg qd [5,10 mg].
2. Non-Cardioselective Beta-Blockers
a. Propranolol LA (Inderal LA), 80-160 mg qd [60, 80, 120, 160 mg].
b. Nadolol (Corgard) 40-80 mg qd, max 320mg/d [20, 40, 80, 120, 160 mg].
c. Pindolol (Visken) 5-20 mg qd, max 60 mg/d[5, 10 mg].
d. Carteolol (Cartrol) 2.5-10 mg qd [2.5, 5 mg].
C. Angiotensin-Converting Enzyme (ACE) Inhibitors
1. Ramipril (Altace) 2.5-10 mg qd, max 20 mg/day[1.25, 2.5, 5, 10 mg].
2. Quinapril (Accupril) 20-80 mg qd [5, 10, 20, 40mg].
3. Lisinopril (Zestril, Prinivil) 10-40 mg qd [2.5, 5,10, 20, 40 mg].
4. Benazepril (Lotensin) 10-40 mg qd, max 80mg/day [5, 10, 20, 40 mg].
5. Fosinopril (Monopril) 10-40 mg qd [10, 20 mg].
6. Enalapril (Vasotec) 5-40 mg qd, max 40 mg/day[2.5, 5, 10, 20 mg].
7. Moexipril (Univasc) 7.5-15 mg qd [7.5 mg].
D. Angiotensin Receptor Blockers
1. Losartan (Cozaar) 25-50 mg bid [25, 50 mg].
2. Valsartan (Diovan) 80-160 mg qd; max 320 mgqd [80, 160 mg].
3. Irbesartan (Avapro) 150 mg qd; max 300 mg qd[75, 150, 300 mg].
4. Candesartan (Atacand) 8-16 mg qd-bid [4, 8,16, 32 mg].
5. Telmisartan (Micardis) 40-80 mg qd [40, 80mg].
E. Calcium Entry Blockers
1. Diltiazem SR (Cardizem SR) 60-120 mg bid
[60, 90, 120 mg] or Cardizem CD 180-360 mg qd [120, 180, 240, 300 mg].
2. Nifedipine XL (Procardia-XL, Adalat-CC) 30-90 mg qd [30, 60, 90 mg].
3. Verapamil SR (Calan SR, Covera-HS) 120-240mg qd [120, 180, 240 mg].
4. Amlodipine (Norvasc) 2.5-10 mg qd [2.5, 5, 10mg].
5. Felodipine (Plendil) 5-10 mg qd [2.5, 5, 10 mg].
