HYPERTENSION High Blood Pressure OMC Wellness Center

Transcription

1 Well Aware Health Improvement Program HYPERTENSION High Blood Pressure OMC Wellness Center Click here to continue

2 Authors of information: Cindy Floyd MSN, FNP-BC Director of Wellness and Well Aware Health Coach Marla Rabalais RD Registered dietician Don Lusk RPH, Pharm D. OMC Pharmacist

3 Well Aware Benefit Plan Review of Goals Purpose and Mission of the Well Aware Program: To empower Oconee Medical Center employees and their families to reach their best state of health. How will this program benefit the employees, their spouse and OMC? Health Coaches will be available to assist you in decreasing risk factors and improving lifestyle choices which will lead to better health. Better health leads to the following: Improves your outlook on life Increases your energy level Increases employee productivity Decreases absenteeism Decreases your personal medical cost Saves OMC money allowing cost savings to be reinvested into additional benefits for all employees

4 Compliance with the 2012 Risk Management Focus: Hypertension 1. Complete Hypertension Assessment 2. Complete online educational session and post test 3. Drop-in blood pressure check in the Wellness Center during the month of March 4. 1:1 Health Coach visits based on level of control and severity but not mandatory unless warranted

5 Hypertension Management Part 1 What is hypertension How it affects the body Measurement of blood pressure Risk and complications General overview of treatment to lower blood pressure

6 Hypertension What is it? A dangerous condition where blood pressure is persistently higher than normal It is mainly due to clogs or blockages in arteries requiring the heart to pump harder to get blood flowing throughout the body Causes damage in the walls of the arteries over time and ultimately can damage the heart Your heart beats about 100,000 times a day; if you have hypertension, damage can be done with each beat

7 Blood Pressure Measurements There are two measurements when determining blood pressure: Systolic/Diastolic Systolic top number The pressure exerted on the arteries when the heart beats/pumps Diastolic bottom number The pressure exerted in between beats (when the heart is at rest)

8 Blood Pressure Measurements Stage 2 Hypertension: More than 160/100 Stage 1 Hypertension: /90-99 Pre-hypertension: /80-89 Normal: less than 120/80

9 Diagnosis Hypertension One reading cannot diagnose hypertension Need 2 or more readings by your doctor or other health professional, 2 minutes apart for 2 or more visits Verify in the other arm

10 The Correct Way to Measure BP Best time to check: late AM or early afternoon Best not to check in early AM as will be higher than later times due to high Cortisol levels in blood stream. Do not test during time of increased pain or stress Measure at least 30 minutes after last meal, caffeine or nicotine. Bladder should be empty Should rest at least 5 minutes (sitting) prior to test

11 The Correct Way to Measure BP Should be sitting in a chair with a back rest while testing Cuff should be at level of heart, so place arm on a table. Do not hold arm out mid-air for test or rest in lap. Relax arm and shoulder muscle while testing Use instrument that is routinely calibrated for accuracy. Finger measurements have been found to be inaccurate. Use correct cuff size Take your personal cuff in to physician s office so comparison testing can be done.

12 Record keeping Purchase a home measurement cuff Blood pressure machines available at: OMC Ambulatory Pharmacy Always record your measurements with date and time. Take record with you to physician s office so trends can be seen from readings.

13 Hypertension Risk High blood pressure is called the silent killer because it contributes to deadly health conditions (heart disease) and there are NO symptoms Of those with hypertension, 1 out of 3 do not even know they have it! Therefore, to avoid health problems, awareness and early intervention are essential!

14 Complications of Hypertension Coronary Artery Disease Atherosclerosis plaque deposits narrow diameter

15 Complications of Hypertension Arteriosclerois hardening of the arteries Aneurysm ballooning out in wall of vessel Hemorrhagic Stroke blood vessel rupture in part of brain Ischemic Stroke lack of oxygen to part of brain

16 Complications of Hypertension Heart Failure Dementia Kidney failure Impotence Vision loss Stroke

17 Treating Hypertension Lowering blood pressure can greatly reduce risk for serious health problems Small changes in lifestyle can lower blood pressure: Dietary management Weight Loss (even a small amount 10%) Smoking Cessation Regular physical activity Limit alcohol intake Increase fruits, vegetables and whole grains Stress Management Medication

18 Smoking Increases BP 7 seconds after the first puff, nicotine reaches the brain signaling the release of epinephrine (adrenaline). Epinephrine narrows blood vessels forcing the heart to beat harder under higher pressure. After 2 cigarettes the systolic and diastolic BP increases about 10 mm Hg and keeps it there for at least 30 minutes. Chain smoking keeps the BP higher over longer periods of time. Smoking and high blood pressure combined increases your risk for a heart attack, heart failure and stroke.

19 Smoking Cessation classes American Cancer Society s Freshstart program offered here at OMC Wellness Center. Classes consist of 3 (1 hour) sessions Free to anyone, but must register by calling the Wellness Center at Offered quarterly.

20 Learning Check Do most individuals have symptoms that alert them that they may have hypertension? YES NO

21 Learning Check Hypertension can cause which of the following conditions? Heart Failure Vision Loss Stroke Kidney Failure Dementia ALL OF THE ABOVE

22 Learning Check Normal blood pressure is below 100/90 130/90 120/80 150/100

23 Learning Check To diagnose hypertension, you should have your blood pressure taken on more than one visit to your doctor with two readings each visit, at least 2 minutes apart. TRUE FALSE

24 Learning Check The best time to take blood pressure is early morning and late afternoon. TRUE FALSE

25 Learning Check To get the most accurate blood pressure reading you should do which of the following: Lay down Have your arm hanging straight down Drink a cup of coffee Empty your bladder

26 Learning Check Blood pressure can be lowered by lifestyle changes such as which of the following. Losing Weight Not smoking & limiting alcohol intake Eating more fruits, vegetables, & whole grains Regular exercise All of the above

27 Learning Check After 2 cigarettes the systolic and diastolic BP increases about 10 mm Hg and keeps it there for at least 30 minutes. T/F TRUE FALSE

28 Hypertension Management Part 2 Dietary Management DASH DIET Sodium Reduction Caffeine Reduction Food restrictions with Medications

29 DASH Diet DASH = Dietary Approaches to Stop Hypertension The diet is lower in sodium and higher in potassium, calcium, magnesium and fiber. Evidence indicates that the DASH diet creates a synergy between nutrients that helps lower blood pressure, potentially as much as one prescription medication.

30 DASH Diet Dash has been called a Diet for all Diseases because the benefits of DASH extend beyond hypertension to a decreased risk of developing certain cancers, diabetes and osteoporosis. Dash can benefit everyone! Making a few simple changes, one step at a time, can lead you down a path of good health.

31 DASH Diet recommendations Fruits Daily Goal: 2-2 1/2 cups Examples of a ½ cup portion include: 1 medium fresh fruit, 16 grapes, ½ cup fresh, canned or frozen, ¼ cup dried, or 4 oz 100% juice If you don't eat fruit now or have only juice at breakfast, add a serving to your meals or have it as a snack.

32 DASH Diet recommendations Vegetables Daily Goal: 2-2 1/2 cups Examples of a ½ cup portion include: 1 cup leafy greens, ½ cup raw, canned* or frozen, or 4 oz 100% juice * when purchasing canned foods choose low sodium option If you now eat one or two vegetables a day, add a serving at lunch and another at dinner.

33 DASH Diet recommendations Fat-free or Lowfat Milk and Dairy Daily Goal: 2-3 cups Examples of a 1 cup portion include: 8 oz milk, 8 oz yogurt Gradually increase dairy products to three servings per day. For example, drink milk with lunch or dinner, instead of soda, alcohol, or sugar-sweetened tea. Choose low-fat (1 percent) or fat free (skim) dairy products to reduce total fat intake.

34 DASH Diet recommendations Whole Grains Daily Goal: 6-8 ounces Examples of a 1 oz portion: 1 oz slice of bread, ½ cup cooked rice or pasta, ½ - 1 ¼ cup dry cereal* * Always check the nutrition fact label on cereal before buying.

35 DASH Diet recommendations Lean Meat, Fish, Poultry Daily Goal: 6 ounces or less Note: a 3 oz portion roughly equals the size of a deck of cards Treat meat as one part of the whole meal, instead of the focus.

36 DASH Diet recommendations Nuts, Seeds, and Legumes Daily Goal: 4-5 portions per week Examples of a portion: 1/3 cup or 1 ½ oz. nuts, 2 Tbsp peanut butter, ½ oz. seeds, ½ cup cooked dry beans, peas or lentils. Note: These portions can count as a 2 oz. portion of lean meat, fish, or poultry. Include two or more vegetarianstyle (meatless) meals each week.

37 DASH Diet recommendations Use sparingly Oils and Fats Examples of a 1 teaspoon portion: 1 tsp soft margarine, 1 Tbsp low-fat mayo, 2 Tbsp low-fat salad dressing or 1 tsp. olive oil or canola oil Use only half the butter, margarine, or salad dressing you do now Try low-fat or fat free condiments, such as fat free salad dressings

38 DASH Diet recommendations Use sparingly Added Sugar Examples of one serving: 1 Tbsp. sugar, 1 Tbsp jelly or jam, ½ cup sorbet and ices or 1 cup lemonade, 1 cup sweet tea

39 DASH Diet recommendations Alcohol One drink is equivalent to: 12 oz beer, 5 oz wine, 1.5 oz spirits Men: 2 or less drinks per day Women: 1 or less drinks per day

40 DASH Diet recommendations Sodium 1 teaspoon of salt = 2,300 mg of sodium Dietary sodium comes primarily in the form of salt or sodium-chloride. Sodium is found naturally in some foods. However, it is the sodium from added salt, especially in many processed foods, restaurant meals, and shaken on that really adds up.

41 Sodium ( Salt ) Intake The average American gets about 3,400 mg of sodium a day twice what is recommended.

42 Recommended Sodium Intake Age 51 years or older: African American : If have Hypertension: If have Hypertension & Kidney Disease: Everyone else: < 1500 mg/day < 1500 mg/day < 1500 mg/day < 1500 mg/day < 2300 mg/day

43 Lowering Sodium To lower sodium, be aware of sodium content in foods : 1 teaspoon table salt: 2300mg 1 teaspoon of sea salt: 2250mg 1 packet of salt, single serving: 400mg 1 oz cheddar cheese: 170 mg 1 dill pickle 2.5 oz : 900 mg 1 average Lean Cuisine: 700 mg 1 cup tomato sauce: 1200 mg 2 slices of a pepperoni & cheese pizza: 1770 mg ½ cup chicken noodle soup: 890 mg 1 instant noodle lunch: 1,240 mg

44 Caffeine Increases BP Caffeine increases blood pressure by: Narrowing blood vessels. This vasoconstriction or narrowing is a result of caffeine blocking the hormone adenosine release. Adenosine helps keep the vessels widened. Raising heart rate. Caffeine causes the adrenal glands to release more cortisol and adrenaline which both increase heart rate.

45 Limit Caffeine Found in coffee, tea, soft drinks and chocolate Limit to about 200 mg /day Amount of Caffeine in: Coffee, ¾ cup or 6 oz = 103 mg Tea, ¾ cup or 6 oz = 100 mg Soft Drink, 12 oz = 70 mg 1 chocolate bar, 1 ½ oz = 10 mg 2 to 3 cups of coffee has been shown to raise systolic BP 14 mm Hg and diastolic BP 13 mm Hg It is also advised to avoid caffeine right before activities that naturally increase BP, such as exercise or hard physical labor.

46 Food/Drinks that interfere with medications If on a Calcium Channel Blocker avoid Grapefruit and grapefruit juice Seville (sour) oranges Natural Licorice often added to chewing tobacco and some cough drops It increases BP by making your kidneys retain sodium and fluid High doses of calcium can interfere with some BP medications

47 Learning Check For men, the DASH diet recommends limiting alcohol intake to 4 or less drinks per day. T/F TRUE FALSE

48 Learning Check Following the DASH Diet (Dietary Approaches to Stopping Hypertension), can also help lower your risk for developing diabetes, certain cancers, and osteoporosis. TRUE FALSE

49 Part 3 Hypertension Management Medication Management Physician driven Classifications Actions Dosing regimens Side effects Monitoring (liver and renal function) recommendations Guidelines for adding medications OTC and other medications that increase BP Taking medications correctly Financial support

50 Classifications of Hypertension Medications There are several different types of medicines the physician may prescribe to help control high blood pressure. Each type works differently (different sites in the circulatory system, different mechanisms, etc.). Sometimes, multiple medications from different classes may be needed for appropriate blood pressure control. The physician and you will make these decisions.

51 Drug Classes Diuretics Angiotensin-converting enzyme (ACE) inhibitors Angiotensin-II receptor blockers (ARBs) Beta blockers Calcium channel blockers Renin inhibitors Alpha blockers Central agonists Vasodilators Combination medications

52 Medications that INCREASE BP Over-the-Counter Meds: Cold remedies Nasal decongestants Appetite suppressants Non-steroidal anti-inflammatory drugs (NSAIDS) such as adult aspirin, Advil, Motrin, and Aleve Prescription Meds: Steroids (Medrol dose paks, Deltasone) Tricyclic antidepressants (Elavil, Asendin, others) Cyclosporine (Neoral, Sandimmune, others) Epoetin alpha (Procrit, Epogen) COX-2 inhibitors (Celebrex)

53 Medications to Lower BP Needed if lifestyle changes are not effective Most can control BP on one medication, others may need a combination of two or three drugs A diuretic, beta blocker or ACE inhibitor is often prescribed for uncomplicated cases Most have minimal side effects Finding the right drug or combination may require time and patience Read the handouts given at the pharmacy when you have your prescription filled Talk to your pharmacist and physician if you have questions

54 Take Your Medications Correctly Take as prescribed and at the same approximate time each day Too early, can produce overdose symptoms and side effect symptoms such as nausea and diarrhea Too late or forget to take, allows BP to increase, sometimes to higher levels than at start of treatment Know the names of your medications Tell your doctor about other medication (including OTC and nutritional supplements) Take medications with water

55 Learning Check Over the counter medications such as cold remedies, appetite suppressants, NSAIDS (such as aspirin, Advil and Aleve) can increase blood pressure. TRUE FALSE

56 There will be no post test questions on the following medication information. Please scroll forward through the following slides to find your current medication and learn more about how it works and possible side effects. You are not required to know all information about all of these medications.

57 Diuretics Help the body get rid of excess sodium (salt) and water by allowing more to be passed into the urine by the kidneys. This reduces the amount of fluid in the bloodstream leading to lower pressure. Usually taken once or twice a day or as directed by the physician. Unless otherwise directed, try not to take med too late in the evening so as not to be awakened during the night for urination.

58 Diuretics There are 3 basic types of diuretics that work in different parts of the kidney: Thiazide diuretics Hydrochlorothiazide (HCTZ), Chlorthalidone (Hygroton), Clorothiazide (Diuril), Indapamide (Lozol), Metolazone (Zaroxolyn) Loop diuretics Furosemide (Lasix), Bumetanide (Bumex), Torsemide (Demadex) Potassium-sparing diuretics Spironolactone (Aldactone), Amiloride (Midamor), Triamterene (Dyrenium) Combinations diuretics are also available: Triamterene + HCTZ (Maxzide, Dyazide), Amiloride + HCTZ (Moduretic), Spironolactone + HCTZ (Aldactazide)

59 Diuretics Side Effects/Monitoring May decrease the body s supply of Potassium. Watch for symptoms such as weakness, leg cramps, or tiredness. Dietary changes or a potassium supplement may be suggested by the physician to help replenish potassium. Also, the physician may change the drug to a Potassium-sparing diuretic. This may decrease the amount of potassium lost in the urine. Increases urination. Try not to take too late in the evening or too close to bedtime. Low blood pressure. Because of the change in blood volume, blood sugar levels may increase. Notify the physician if this is significant. Prolonged use may trigger an attack in someone who suffers from gout. A small percentage of men may experience erectile dysfunction. Try to take Metolazone (Zaroxolyn) about 30 minutes BEFORE a dose of a loop diuretic (Lasix, Bumex, Demadex). This will increase the amount of fluid excreted.

60 Angiotensin Converting Enzyme (ACE) Inhibitors Angiotensin is a chemical that causes the arteries throughout the body to become more narrow especially in the kidneys. These medications help to prevent the production of Angiotensin by blocking the enzyme that is needed for its conversion to an active form. This in turn helps the blood vessels relax and open up, which helps to lower blood pressure These are usually taken once or twice a day or as directed by the physician. The progression of kidney disease or dysfunction due to high blood pressure or diabetes may be slowed.

61 ACE Inhibitors Medications in this class include: Benazepril (Lotensin) Captopril (Capoten) Enalapril (Vasotec) Fosinopril (Monopril) Lisinopril (Prinivil, Zestril) Moexipril (Univasc) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) (Notice the generic names of these medications end with the letters PRIL )

62 Side Effects/Monitoring ACE Inhibitors Watch for a chronic dry or hacking cough. If this becomes severe or a nuisance, notify the physician. Low blood pressure Loss of taste Skin rashes Potassium imbalance In rare instances kidney damage Women who are pregnant or considering pregnacy should see their physician immediately. These drugs could potentially harm the fetus.

63 Angiotensin-II Recptor Blockers (ARBs) These drugs are somewhat similar to ACE Inhibitors. ARBs block the effects of Angiotensin on the body, a chemical which causes the arteries to become narrow. Angiotensin needs a receptor (like a key fits into a lock ) in order to constrict blood vessels. ARBs block these receptors, resulting in blood vessels staying relaxed and open. This helps to lower blood pressure. SO Whereas ACE inhibitors help prevent Angiotensin from becoming active, ARBs help block the receptors so that however much Angiotensin is already active is less likely to work. The progression of kidney disease or dysfunction due to high blood pressure or diabetes may slowed.

64 Angiotensin Receptor Blockers Drugs in this class include: Candesartan (Atacand) Eprosartan (Teveten) Irbesartan (Avapro) Losartan (Cozaar) Telmisartan (Micardis) Valsartan (Diovan) (Notice that the generic names for these drugs end with the letters SARTAN )

65 Angiotensin Receptor Blockers Side Effects/Monitoring Chronic dry or hacking cough but not as prevalent as ACE inhibitors Low blood pressure Occasional dizziness Women who are pregnant or considering pregnancy, should notify their physician immediately. These drugs could potentially harm the fetus.

66 Beta Blockers Beta Blockers interfere with specific receptors in the body (beta receptors). These medications reduce the heart rate, reduce the heart s workload (strength of contractions), and reduce the output of blood (stoke volume). All of these actions help to lower blood pressure and preserve heart muscle. Beta blockers may also be useful in patients with heart failure, who have had a heart attack, or have an irregular heart rhythm. These medications are usually taken once or twice a day or as directed by a physician. Dosing is usually started low, then increased as tolerated. ( Start low Go slow )

67 Beta Blockers Medications in this class include: Acebutolol (Sectral) Metoprolol tartrate (Lopressor) Atenolol (Tenormin) Metoprolol succinate (Toprol XL) Betaxolol (Kerlone) Penbutolol (Levatol) Bisoprolol (Zebeta) Pindolol (Visken) Carteolol (Cartrol) Propranolol (Inderal) Carvedilol (Coreg) Sotalol (Betapace) Nadolol (Corgard) Timolol (Blocadren) Nebivolol (Bystolic) Labetolol (Trandate, Normodyne) has both beta blocker & alpha blocker effects (Notice that the generic names for these drugs end with the letters OLOL )

68 Beta Blockers Side Effects/Monitoring Insomnia Low blood pressure Nightmares Tiredness ( washed-out feeling) Depression Slow heartbeat Symptoms or aggrevation of asthma Erectile dysfunction may occur. May affect blood sugar and response to insulin. Monitor blood sugar closely. Irregular heart rhythms notify physician immediately. Consult physician if you are pregnant or considering pregnancy. Do not suddenly stop beta blockers or skip a number of doses. Can result in heart racing, elevated blood pressure, anxiety, and chest pain. Beta blockers may not be indicated for patients with emphysema or COPD discuss usage with physician.

69 Calcium Channel Blockers Help decrease the amount blood vessels can contract and helps them to dilate. The vessels narrow when calcium flows through calcium channels in the muscle cells within the arteries. This causes blood pressure to increase. The medication helps to block calcium entry into these channels allowing the vessels to widen. These effects lower blood pressure and heart rate. Usually taken once to three times a day depending on formulation of the tablet/capsule or as directed by the physician. Some drugs in this class may also be used to help control heart rate and rhythm.

70 Calcium Channel Blockers Medications in this class include: Amlodipine (Norvasc) Felodipine (Plendil) Isradipine (DynaCirc) Nicardipine (Cardene) Nifedipine (Procardia) Nisoldipine (Sular) Diltiazem (Cardizem, Tiazac, Cartia) Verapamil (Calan, Isoptin, Verelan) (Note that most of the generic names end in the letters IPINE EXCEPT for Diltiazem and Verapamil)

71 Calcium Channel Blockers Side Effects/Monitoring Avoid grapefruit juice while on these medications. The levels of drug in the body may increase and become toxic. Swelling of feet or legs Swollen gums Headache (although may be used for migraines) Low blood pressure Low heart rate Erectile dysfunction may occur. Monitor for changes in heart rhythm notify physician immediately if noted.

72 Renin Inhibitors Renin is an enzyme produced in the kidneys that starts a chain of chemical steps which increase blood pressure. This chain reaction leads to the steps which include Angiotensin. This class of medication helps to block the production of Renin. This is turn helps to reduce blood pressure Usually taken once daily.

73 Medication in this class: Aliskiren (Tekturna) Side Effects/Monitoring Low blood pressure Potassium disturbances Renin Inhibitors Swelling in legs or feet. If severe or nuisance, or occurs anywhere else in the body, contact the physician. Use with caution in patients who already have decreased kidney function. Do not use if pregnant or considering pregnancy. May result in harm to the fetus. Consult the physician.

74 Alpha Blockers Reduce the resistance within arteries by blocking alpha receptors. This relaxes the muscle tone in the walls of the blood vessels. This results in helping to lower blood pressure. Usually taken once daily. May also be used in men to help with symptoms associated with enlarged prostate.

75 Alpha Blockers Medications in this class include: Doxazosin (Cardura), Prazosin (Minipres), Terazosin (Hytrin), Labetolol (Normadyne, Trandate) has both alpha blocker and beta blocker effects Side Effects/Monitoring Low blood pressure Dizziness Fast heart rate Rapid drop in blood pressure upon standing up (orthostatic hypotension). May be directed to take medication at night to sleep through this side effect. Men: this class of medication not usually indicated if taking drugs for erectile dysfunction (Viagra, Cialis, Levitra). Consult physician.

76 Central Agonists Central agonists help to decrease the ability of the blood vessel to tense up or contract. These medications follow a different pathway than either alpha blockers or beta blockers. By decreasing constriction in the blood vessels, the blood pressure within the vessels is decreased. May be taken once or multiple times a day as directed by the physician.

77 Central Agonists Medications in this class include: Clonidine (Catapres), Guanfacine (Tenex), Methyldopa (Aldomet) Side Effects/Monitoring Low blood pressure Erectile dysfunction may occur. Dry mouth, constipation, blurred vision Drowsiness/Sluggishness Fever Anemia May produce a greater drop in blood pressure when standing or walking, or feel faint. If this persists or is severe, notify the physician. Do not stop these medications suddenly because blood pressure may rise very quickly. Methyldopa may be considered for pregnancy because the adverse effects are infrequent for the pregnant woman or the developing fetus. Clonidine is available in a once-a-week patch. There are different dosages and absorption through the skin may be variable in different patients.

78 Vasodilators These drugs act on small arteries through direct effects on the muscle in the walls of the arteries. This causes the muscles in the walls of the arteries to relax, allowing the vessels to dilate or widen. Therefore, blood flows easier through the vessels and helps to reduce blood pressure. Usually taken once or multiple times a day as directed by the physician.

79 Vasodilators Medications in this class include: Hydralazine (Apresoline), Minoxidil (Loniten) Side Effects/Monitoring Hydralazine may cause headaches, swelling (especially around the eyes), heart palpitations, low blood pressure, and joint aches/pain. Most side effects will usually go away after a few weeks. If they persist or are severe, inform the physician. Minoxidil usually only used in resistant cases of severe high blood pressure or when kidney failure is present. It may cause fluid retention, marked weight gain, or excessive hair growth.

80 Combination Drugs Combination drugs are 2 or 3 medications contained in the same pill. Dosages are fixed in the combination pill, so it may be more difficult to adjust dosages. However, it may be easier to take the medication because the patient is taking fewer pills. Refer to the previous slides on each medication class for information on the drugs contained in the combination pill.

81 Combination Drugs ACE Inhibitor + Diuretic Benazepril + HCTZ (Lotensin HCT) Captopril + HCTZ (Capozide) Enalapril + HCTZ (Vaseretic) Fosinopril + HCTZ (Monopril HCT) Lisinopril + HCTZ (Prinzide, Zestoretic) Moexipril + HCTZ (Uniretic) Quinapril + HCTZ (Accuretic) ARBs + Diuretic Candesartan + HCTZ (Atacand HCT) Eprosartan + HCTZ (Teveten HCT) Irbesartan + HCTZ (Avalide) Losartan + HCTZ (Hyzaar) Olmesartan + HCTZ (Benicar HCT) Telmisartan + HCTZ (Micardis HCT) Valsartan + HCTZ (Diovan HCT) Beta Blocker + Diuretic Nadolol + Bendroflumethazide (Corzide) Atenolol + Chlorthalidone (Tenoretic) Bisoprolol + HCTZ (Ziac) Metoprolol tartrate+hctz (LopressorHCT) Propranolol + HCTZ (Inderide) Central Agonist + Diuretic Clonidine + Chlorthalidone (Clorpres) Methyldopa + HCTZ (Aldoril) Renin Antagonist + Diuretic Aliskiren + HCTZ (Tekturna HCT)

82 Combination Drugs Calcium Channel Blocker + ACE Inhibitor Amlodipine + Benazepril (Lotrel) Verapamil + Trandolapril (Tarka) Felodipine + Enalapril (Lexxel) Calcium Channel Blocker + ARBs Amlodipine + Olmesartan (Azor) Amlodipine + Telmisartan (Twynsta) Amlodipine + Valsartan (Exforge) Calcium Channel Blocker + Renin Antagonist Aliskiren + Valsartan (Valturna) Calcium Channel Blocker + ARBs + Diuretic Amlodipine + Valsartan + HCTZ (Exforge HCT)

83 Conclusion Hypertension is a serious risk factor for disease; however, it can be prevented and treated through lifestyle changes and proper medication!! But remember it is a silent killer, so please take action NOW!! Your Well Aware Health Coaches are here to help!