The Curbsiders Internal Medicine Podcast

#343 Hypertension FAQ and Cardiorenal: A rapid review (TFTC)

Jun 29, 2022
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ADVICE

Start Low‑Dose Combination Therapy

  • Start low‑dose combination therapy rather than maxing a single agent to improve control and reduce side effects.
  • Use quarter to half doses of two complementary classes (eg, CCB + ACE/ARB) for faster control.
ADVICE

Dose Thiazides Effectively; Monitor Electrolytes

  • Use thiazides at effective doses: start hydrochlorothiazide at 25 mg rather than 12.5 mg.
  • Prefer chlorthalidone for potency but adjust dosing (25 mg every other day or half‑tablet) and monitor electrolytes.
INSIGHT

Diuretics Work In CKD — Don't Dismiss Them

  • Chlorthalidone remains effective in many CKD patients and lowered BP in the CLICK trial.
  • Use diuretics in CKD when indicated, but follow electrolytes and creatinine closely.
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