- Joined
- Aug 24, 2015
- Messages
- 468
- Reaction score
- 154
For exam purposes, can we give Hydrochlorothiazide to a pregnant woman with chronic severe hypertension, or is it contraindicated?
Blacks often have stiffer vessels and I'd go with a dihydropyridine CCB over a thiazide initially, in the absence of heart failure. In a black with heart failure, we'd be looking at an ACEi/ARB first, followed by a beta-blocker (bisoprolol, metoprolol-XR, carvedilol, or nebivolol, only), followed by spironolactone, followed by hydralazine and isosorbide dinitrate. I'm over-simplifying the HF Tx scheme for the sake of this thread, but the two points I want to make are 1) blacks benefit from afterload reduction (so in the absence of HF it makes no sense to choose a thiazide over a dCCB), and 2) hydralazine + isosorbide dinitrate, as a combination, yields extra mortality benefit in this group, in the setting of heart failure.Also for reference, usually thiazides are for people who have hypertension due to a high salt diet. This is usually found in canned foods (as a preservative) and for patients in poverty stricken areas. An poor african-american/black patient is a classic type of case.
Blacks often have stiffer vessels and I'd go with a dihydropyridine CCB over a thiazide initially, in the absence of heart failure. In a black with heart failure, we'd be looking at an ACEi/ARB first, followed by a beta-blocker (bisoprolol, metoprolol-XR, carvedilol, or nebivolol, only), followed by spironolactone, followed by hydralazine and isosorbide dinitrate. I'm over-simplifying the HF Tx scheme for the sake of this thread, but the two points I want to make are 1) blacks benefit from afterload reduction (so in the absence of HF it makes no sense to choose a thiazide over a dCCB), and 2) hydralazine + isosorbide dinitrate, as a combination, yields extra mortality benefit in this group, in the setting of heart failure.
I was under the impression that most physicians use thiazide like HCTZ in African Americans (AA) because of their diuretic effects (i.e their mechanism of action) since it's well known that AA use a lot of salt in their diet. But I think dCCB such as norvasc would also be good DOC to treat HTN in AA. Treating B/P sometimes varies wildly among physicians.
That's probably a better way to say it!"AA use a lot of salt in their diet." Are we making conclusions that we know how AAs eat? Apparently they are better salt retainers though. That could be an explanation to use thiazides.
I was under the impression that most physicians use thiazide like HCTZ in African Americans (AA) because of their diuretic effects (i.e their mechanism of action) since it's well known that AA use a lot of salt in their diet. But I think dCCB such as norvasc would also be good DOC to treat HTN in AA. Treating B/P sometimes varies wildly among physicians.
It's due to poverty, they eat a lot of canned foods that contain salt as a preservative. If you have a white/hispanic/rainbow-colored patient that lives in the same poverty stricken area, you would give the same treatment, thiazides. It's not solely based ethnicity, it's socio-economic factors. But anyways that's why your go-to for a practice question for a poor AA with hypertension is thiazides."AA use a lot of salt in their diet." Are we making conclusions that we know how AAs eat? Apparently they are better salt retainers though. That could be an explanation to use thiazides.