Emergency Medical Minute

Contributor: Alec Coston, MD Educational Pearls: For patients presenting to the emergency room with hypertension, clinicians should determine if it is isolated and uncomplicated, or involves comorbidities with more complex underlying pathophysiology.  For uncomplicated and isolated hypertension, first-line treatment is thiazide diuretics.  How do thiazide diuretics work to treat hypertension? Thiazide diuretics work by blocking sodium and chloride resorption in the kidneys.  “Where sodium goes, water follows,” thus promoting diuresis and lowering blood pressure. Examples of thiazide diuretics and their benefits? Hydrochlorothiazide (HCTZ): First-line medication in uncomplicated and chronic hypertensive states. Cheaper and fewer significant adverse effects compared to chlorthalidone. HCTZ can be associated with decreased risk of stroke and myocardial infarction. However, for more complicated hypertension, especially in the setting of heart failure, Angiotensin Converting Enzyme (ACE) Inhibitors should be co