Table 8. Screening tests for identifiable hypertension Diagnosis Duscnostic Test Chronic kidney disease Estimated GFR Coarctation of the aorta CTangiography Cushing's syndrome and other glucocorticoid ‘xcoss states Including chronic storold therapy History; dexamethasone suppression test Drug induced /telated (see table 18) History; drug screening, Pheochromocytoma 2e-hour urinary metanephrine and normotanephrine Primary aldosteronism and other mineralocorticoid excess states ‘24-hour urinary aldosterone level or specific measurements of other mineralocorticoids. Renovascular hypertension Doppler fiow study; magnetic resonance angiography Sleep apnea Sleep study with O2 saturation ‘Thyroid/ parathyroid disease ‘TSH; serum PTH computed tomographry; GFR. glomerulor filtration rate; PTH, parathyroid hormone; TSH, thyroid-stimulating hormoneRawoeim | USUAL Dat cuss Due (TeaDe Name) Sebo sabe Thiszide diuretics hlorothacide Divi) 125-500 2 tlorthalidone (generic) 25-25 1 Inydrochlorothazide (Wronde, HyéroDIURIL) 25-50 1 polythiazde Renese) m4 1 indapamide Lozot) saps 1 metolazone (ykrax) 2510 1 metlazone @aroxolyn) 255 1 Loop lureics Dbumetanie (umex?) os 2 furosomido (Las) 2 {orsomide (Demadex?) 1 Potassium-sparing duretics ‘amiloride (Midarnor) 2 ‘wiamterene(Oyrenium) 2 ‘Aldosterone receptor blockers ‘eplerenone dnspra) 1 spironolactone Aldactone’) 1 8s _atonotl (enor) 25100 1 betaxolol erin") 520 1 bisoproto Zebeta) 25210 1 metoprolot lopressor) 59-200 a metoprolo extended release (Toprol XL) 50-100 1 ‘nadolol (Conga) soo 1 propranolol era? 40-160 2 propranolol long-acting Vnderal LA) 60-180 1 timolol Blocadren) 20-40 2 BBs with intrinsic sympathomimetic | acobutlol Sacra) 200-800 2 ctvty penbutolol Levatol) 0-40 2 pindotet (generic) 10-40 2COMPELLING INDICATION" ‘CuNIcaL TRIAL Basist g = : < 2/8|2/8/8/2 eart tlle ef ele] |e | Accrans near rue cuidetine = meer. His) COPERNICUS 26 C1BI,95 SOLWD.9= -AIRE,97TRACE,* VAIN ALES, ines: Postmyocaria infarction ele © | ACC/AHA Post-mi Guideline? BHAT3 SAVE, 98 Capricorn. EPHESUS High coonarydlseaserisk | @ | @| | |e | | aunates Hope.s2anara.%= uFE= (CONVINCE 0 EUROPA INVEST? Diabetes ef ele fe) | nkrAna cuietness8> uKPoS.v# ALLHAT=S Chronic Kidney disease ele TNKFGuidatine Captopril? RENAL => [INT=1 REI: AASK'=3 Recurrent stoke prevention | @| | © PROGRESS AASK, Ajrcon American Stuy of Kidney Disease and Hypertension; ACCAHA, American College of Cardiclogy/American Heart Association; ACEI, angiotensin converting enzyme inhibitor: AIRE, Acute Infarction Rarmiorl Efficacy: Aldo ANT, ‘aldosterone antagonist; ALLHAT, Antihypertensive and Lipia-Lowering Treatment to Prevent Heart Attack Tria: ANBP2, ‘Second Australian National Blood Fressure Study; ARB, angiotensin receptor blocker BB, beta blocker; BHAT, fi Blocker Heart Attack Trial; Capricorn, Cervedile|Post-nfarct Survive! Control in Left Ventricular Dysfunction; CCB, cle- lum channel blockers CHARM. Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbiditv:CIBIS.able 20, Treatment of chronic hypertension in pregnancy a G Accu Comments Methyldopa 1 Profred based on long-term fllomup studios supporting safety 1m Reports of intrauterine growth retardation (atenolol) = Genorally safe Labetatol 1m Increasingly preferred to methyldopa due to reduced side effects Clonidine = Limited data Calcium antagonists m Limited data 1m No increase in major teratogenicity with exposure Diuretics 1m Not first-line agents, = Probably safe ACEls, angiotensin Il receptor antagonists | m= Contraindicated 1= Reported feta toxicity and death