ABCD in hypertension

[Hero]

One of the most recent issues of BMJ (BMJ 2006;332:833-836) reported that the two types of hypertension can be distinguished by measuring plasma renin.
Hypertension in young white people seems to be high renin (type 1) hypertension and best responds to treatment with angiotensin converting enzyme inhibitors and b blockers (AB drugs). Hypertension in young black people, however, seems to be low renin (type 2) hypertension and responds better to calcium channel blockers and diuretics (CD drugs).

[CSF]

thats a very useful mnemonics, thanks Hero.

[flirt]

So tell me which drug you prefer for nepalese people ?
A. Enalapril
B. Propanolol
C. Amlodipine
D. Furosemide

[Hero]

You have asked a vague question. In my posting above, you might have noticed that white ppl RESPONDS better to A or B and blacks to C or D. In Nepal no such study has been conducted that's why we rely on international guidelines/ and our own experience. Hypertension is not like APD where you give omeprazole or ranitidine and ask the patient to go home. In your question are you asking about a young Nepalese with hypertension or an old Nepalese dude? Before treating any patient we see whether it is a primary or secondary one? Is there any risk factor? Target organ damage? Then we group that patient as stage 1 ,2 or 3 (in China)--JNC-7 divides into stage 1 and 2 only---and risk group A, B or C???
Lets assume you are talking about a Nepalese male with age more than 55 yrs--essential HTN---stage 1 in risk group A or B---I will suggest him for lifestyle modification, if in risk group C--then I will start medication. I was tought to start with C or D, and I start with D (thiazide group--not frusemide). If the pt is younger (age less than 55, then ACE-I (any type--but I give Fosinopril--don't know whether it is available in Nepal or not) or ARB if ACE-I not tolerated. If pt with DM, then ACE-I or ARB---if with angina then beta blockers--so n so n so. And if the pt doesn't respond to this or for the pts in other stages I give 2 drug combi---usually A+D or A+C, if 3 needed A+C+D. Don't forget to monitor electrolytes frequently. If BP still not controlled then have to consider other things as well. This is what I frequently prefer in my practice and doesn't mean that all do like this.

[Vishal]

wonderful info about hypertension treatment.....thanx Hero
i think u have missed sth...like what if the drug is contraindicated in that patient? overall a gr8 info..thanx

[billiemacias]

That mnemonic will be very useful for me too. Thanks a lot..

[sherazforyou]

this is not the full ABCD rule there is more in this rule so you must post all content. it contains more like when patien is diabetic and so more so why do you post only this much ?

[Soul]

Originally Posted by sherazforyou

this is not the full ABCD rule there is more in this rule so you must post all content. it contains more like when patien is diabetic and so more so why do you post only this much ?

this is not a review article on hypertension. just a conclusion taken from British Medical Journal. if you are interested to elaborate the treatment option in diabetic patients etc etc, then you are welcome, we are here to read. Thanx in advance!