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Antihypertensive MedicationsACE and ARBs are preferred therapy if experiencing hypertension and albuminuria – If B/P not at goal witheither of these agents, add a diuretic or other class. Do not use during pregnancy or in persons w/ renal orhepatic dysfunction. Start w/ low dose, gradually increase. If one class is not tolerated, the other should besubstituted. For those treated with an ACE inhibitor, angiotensin receptor blocker, or diuretic, serumcreatinine/estimated glomerular filtration rate and serum potassium levels should be monitored at leastannually. ADA Standards CV Disease Risk ManagementUsual Daily DoseClass / ActionGeneric / Trade NameFrequencyConsiderationsRangeACE InhibitorsAngiotensinConvertingEnzymeAction - Block theconversion of AT-I toAT-II. Alsostimulates release ofnitric oxide causingvasodilation.ARBs -AngiotensinReceptor BlockersAction -Block AT-Ireceptor whichreduces aldosteronesecretion andvasoconstrictionbenazepril / Lotensin†10 – 40 mg1 x a daycaptopril /Capoten*†12.5 - 100 mg2-3 x a dayEnalopril/ Vasotec*†2.5 - 40 mg1-2 x a dayFosinopil / Monopril†10- 40 mg1 x a dayLisinopril *†PrinivilZestrilRamipril / Altace*†Moexipril / Univasc†Perindopril/Aceon‡10 – 40 mg10 - 40 mg2.5 – 10 mg3.75 - 15 mg2-16 mgTry to take same time eachday. Effects seen w/in 1 hr ofadmin, max effects in 6 hrs.Side effects: Can cause cough(due to increased bradykinin)– can try different med insame class. Also can causefatigue, dizziness,hypotension.†These meds are alsoavailable as a combo w/ lowdose HCTZ(hydrochlorothiazide).Perindopril/Indapamide combo(Coversyl)Quinapril /Accupril†Trandolapril/ Mavik2 - 8 mg0.625 - 2.5 mgTrandolapril/Verapamil combo (TARKA)1-4 mg180 to 240 mgAzilsartan/Edarbi40 - 80 mgAzilsartan/Chlorthalidone combo(Edarbyclor)40 mg12.5 - 25 artan/ Avapro†Losartan / Cozaar*†Olmesartan / Benicar†‡Tribenzor (triple combo)8 – 32 mg400 - 600 mg75 – 300 mg25 – 100 mg20 – 40 mg†These meds are alsoavailable as a combo w/ lowdose HCTZ(hydrochlorothiazide).Telmisartan / MicardisValsartan / Diovan†‡Exforge HCT (triplecombo)20 – 80 mg80 – 320 mg‡These meds are alsoavailable as a combo w/ CCB(calcium channel blocker)usually amlodipineValsartan/Nebivolol combo(Byvalson)80 mg5 mg*indicates medication is available in generic form.‡These meds are alsoavailable as a combo w/ CCB(calcium channel blocker)usually amlodipine5 – 40 mg1.0 – 4 mg1 x dailyTry to take same time eachdaySide effects- Can causedizziness, drowsiness,diarrhea, hyperkalemia,hypotension.PageDiabetes Educational Services 2021 - www.DiabetesEd.net For educational purposes only, see package insert for prescribing info.

Class / ActionGeneric / Trade NameDRIs - Direct ReninInhibitors -Aliskiren / Tekturna†Usual Daily DoseRange150 – 160 mgFrequencyConsiderations1 x dailyGenerally well tolerated.†These meds are alsoavailable as a combo w/ lowdose HCTZ (hydrochlorothiazide).Beta Blockers are commonly prescribed as an add-on to other B/P meds for people with DM. Beta Blockersare beneficial for persons w/ concurrent cardiac problems and prevention of recurrent MI and heart failure.Caution in DM since Beta Blockers can cause hyperglycemia and mask hypoglycemia induced tachycardia(but do not block hypoglycemia related dizziness and sweating). Monitor B/P, heart rate, lipids and glucose.Acebutolol / Sectral*200 – 800 mg2 x dailySide Effects: Usually CNS relatedBeta Blockers1xdailyincluding sedation, dizziness,Atenolol / Tenormin*25 – 100 mgβ1- Selective1 x dailylightheaded .Atenolol with50 -100 mgAction: Blockade1xdailyChlorthalidone/Tenoretic25mgβ1 receptors &2 x dailyWatch for bradycardia,Betaxolol / Kerlone5 – 10 mgreduce cardiachypotension, depression andBisoprolol/ Zebeta†2.5 – 10 mgoutput & kidney1xdailysexual dysfunction. Check heartMetoprolol25 – 100 mgrenin activation.grate each visit, adjust dose if HRBeta BlockersNon SelectiveAction: Blockadesβ1 & β2Combined α- andβ- Blockerstartate/Lopressor*†Metoprolol succinate /Toprol XL25 - 100 mgNebivolol/Bystolic5 to 40 mgNebivolol withValsartan/ ByvalsonNadolol / Corgard*Nadolol withBendroflumethiazidePenbutolol / LevatolPindolol / ViskenPropanolol / Inderal*Inderal LA (extended)Timolol / Blocadren*5 mg80 mg40 - 120 mg40-80 mg5 mg10 - 40 mg10 – 40 mg40 – 160 mg60 – 180 mg10 – 60 mgCorvedilol / Coreg6.25 – 50 mgCoreg CR20 – 80 mgLabetalol / Normodyne* 100 – 2400 mg 50.1 x dailyCan cause heart block – reviewpackage insert for drug-druginteractions. Watch for exerciseintolerance. When stoppingbeta blockers, taper dosegradually. Use cautiously atlowest dose.1 x daily2 x daily2 x daily1 x daily2 x daily†These meds are also availableas a combo w/ low dose HCTZ(hydrochlorothiazide).2 x daily1 x daily2 x dailySame precautions as betablockers.Diuretics are often used as adjunct therapy. Obtain baseline B/P, electrolytes, uric acid, glucose and lipidsprior to starting and periodically. May require supplementation w/ magnesium and potassium.Class / ActionGeneric / Trade NameUsual DailyConsiderationsDose Range12.5 – 25 mg1 x daily in am with or w/out foodThiazide Diuretics Hydrochlorathiazide (HCTZ)*HydroDIURILMost frequentlySide effects: lyte imbalances;Action: causeMicrozideprescribedhypokalemia, hypomagnesemia,diuresis andhyperuricemia, ecrease vascularhyperlipidemia and hyper/hypocalcemia.Metolazone / Zaroxolyn*2.5 – 20 mgresistance.(Many meds combinedwith this class)Indapamide / Lozol**indicates medication is available in generic form.1.2 – 2.5 mgS/S include muscle cramps, fatigue,dizziness and cardiac arrhythmias .PageDiabetes Educational Services 2021 - www.DiabetesEd.net For educational purposes only, see package insert for prescribing info.

Class / ActionGeneric / Trade NameUsual DailyDose RangeConsiderationsLoop Diuretics(resistant HTN)Furosemide/Lasix*20 – 600 mgSide Effects as above, but more intense.Need K supplement.Torsemide / Demadex*2x day2.5 – 200 mg1x dayPotassium SparingDiureticsBumetanide / Bumex*Amiloride / MidamorTriamterene / DyreniumSpironolactone / Aldactone*Eplerenone / Inspra0.5 – 10 mg2 x day5 – 20 mg37.5 – 75 mg25 – 100 mg50 - 100 mgUsed if GFR 30 or if greater diuresis isneeded1 x day1 x day1-2 x day1 -2 x dayUsually combined withthiazide diuretic to balanceserum potassium. Alone,they do little to lower BP.Calcium Channel Blockers are usually second or third line BP med for diabetes, since they have lessimpact on CVD. They may also be used for those who can’t tolerate ACE or ARB Therapy.Usual Daily DoseFrequency ConsiderationsClass / ActionGeneric / Trade NameCalcium ChannelBlockerNondihydropyridineRelaxes coronaryblood vessels todecrease heart rateand cardiac output.Diltiazem immediate release*Range30 – 360 mg4 x day120 – 480 mg120 – 540 mg180 – 540 mg1 x day1 x day1 x day80 -320 mg3 x day120 mg – 480 mg1 -2 x day120 – 480 mg100 – 400 mg2.5 – 10 mg2.5 – 10 mg2.5 – 10 mg1 x day30 – 60 mg2 x day30 – 120 mg1 x day10 – 40 mg1 x dayDiltiazem extended release*Cardizem CDTiazacDilacor, DiltiaVerapamil immediate release*CalanVerapamil sustained release*Calan SR, VeralanVerapamil extended release*Calcium ChannelBlocker –DihydropyridineCauses vasodilationand decreasesperipheral vascularresistance.Covera-HSVerelan PMAmlodipine/NorvascFelodipine / PlendilIsradipine controlled releaseDynaCirc CRNicardipine sustainedrelease / Cardene SRNifedipine long-acting*Adalat CC /Procardia XLNisoldipine / Sular1 x day1 x day1 x dayMonitor BP, heart rate, liverenzymes and cardiacfunction a baseline andperiodically.Take at the same time eachday (with meals if possible).Take in evening ifexperience drowsiness.Side Effects: Watch forcardiac conductionabnormalities, bradycardia,CHF and edema.Can cause peripheral edemaand constipation.Metabolized throughCYP3A4, so review packageinsert for drug and foodinteractions (ie grapefruit).α1 – Receptor Blockers - Often used for pts with DM & benign prostatic hypertrophy (BPH).α1 – osin / Minipress*Terazosin/ Hytrin*1 – 8 mg2 – 20 mg1 – 10 mg1 x day2 - 3 day1 – 2 dayTake at hs and low dose toreduce risk of posturalhypotension/syncope.α2 agonists- Not usually first line due to side effects. Effective in pts w/ renal disease, since does notcompromise renal function.Clonidine / Catapres*α2 agonists –Methyldopa / Aldomet*Centrally act toblock influence ofnorepinephrine onthe heart andlower B/P*indicates medication is available in generic form.0.1 to 0.8 mg2 x day250 – 1000 mg2-3 x dayAdminister w/ diuretic.Side effects: sedation, drymouth, bradycardiaorthostatic hypotension,impotence. Do not stopabruptly, can causehypertensive crisis.PageDiabetes Educational Services 2021 - www.DiabetesEd.net For educational purposes only, see package insert for prescribing info.

Cholesterol MedicationsLDL Lowering MedicationsClass / ActionGeneric / Trade NameUsual Daily DoseRangeLDL %LoweringConsiderations“Statins”Atorvastatin / Lipitor*10 – 80 mg20- 60HMG- CoAReductase InhibitorsFluvastatin / Lescol*Lescol XLLovastatin*MevacorAltoprev XLPravastatin / Pravachol*20 – 80 mg80 mg20- 3520 - 80 mg10 - 60 mg10 - 80 mg20- 45Rosuvastatin / Crestor5 – 40 mg20- 60Simvistatin / Zocor*Pitavastatin / LivaloCholestyramine/Questran*20 – 80 mg2 – 4 mg4 to 16 g per daypowder – 1 scoop 4g20- 55Lowers TGs 7-30%Raise HDL 5-15%Take at night.Side effects: weakness,muscle pain, elevatedglucose levels.Review package insert forspecific dosingadjustments based ondrug, food interactions(ie grapefruit).acids in intestine,decreasing cholesterolproduction.Colesevelam / WelcholLowers A1c 0.5%3.75 x 1 daily1.875 x 2 daily(625mg tablets)Secondary action –raise HDLColestipol / Colestid2 - 16 gms per day tabsPowder – 1 scoop 5g5 to 20 gm per dayMix w/ fluidCholesterolAbsorption InhibitorsEzetimibe / Zetia10 mg – 1x daily15-20%Plant StenolsPlant SterolsBenecolTake Control3 servings daily2 servings daily14%17%Inhibits enzyme thatconverts HMG-CoAto mevalonate limits cholesterolproductionBile AcidSequestrants20- 45Lower LDLby 15-30%Action: Bind to bileMay raise TG levels.Raise HDL 3-5%.Avoid taking in sametimeframe w/ othermeds – may affectabsorption (see packageinsert).Side effects: GI in natureUsually used in combow/statin. Headache, rash.Well toleratedTriglyceride Lowering / HDL Raising MedicationsIf TG 500, lower TG first, then reduce LDL.Class / ActionGeneric / TradeFibrates or FibricAcidsReduces liverlipogenesisFenofibrate/ TricorMultiple brandformulationsNicotinic AcidRaise HDL/Lower TGInhibits mobilizationof free fatty acidOmega 3 Fatty AcidGemfibrozil / Lopid*Niacin (immediate release)*NiaSpan (extended release)Niacin (sustained release)Omega 3 Acid/ LovazaUsual Daily DoseRange48-145 mg 1x dailyPlease refer toindividual packageinsert for dosing600mg 2x daily1.5- 3 gms1-2 gmsLowers TG Considerations4 gm a day45%20-50%20-50%Lowers LDL 5-20%Raise HDL 10-20%GI side effects, myopathyAvoid w/ severe renal orhepatic diseaseRaise HDL 15-35%Flushing, hyperglycemia,hepatoxicity – monitorliver enzymes. Can takew/aspirin to flushingRaise HDL 9% Primary use for TG 500Combination MedicationsVytorinJuvisyncZetia Simvistatindiscontinued*indicates medication is available in generic form.Observe precautions of each component drugPageDiabetes Educational Services 2021 - www.DiabetesEd.net For educational purposes only, see package insert for prescribing info.