What advice is there for taking Brinsupri for blood pressure?

Advice for Taking Brinsupri for Blood Pressure Management

Brinsupri is not indicated for blood pressure management as it is a carbonic anhydrase inhibitor primarily used for ocular conditions such as glaucoma and ocular hypertension, not for systemic hypertension treatment.

Understanding Brinsupri

• Brinsupri (brinzolamide) is a carbonic anhydrase inhibitor formulated as an ophthalmic suspension for reducing intraocular pressure by decreasing aqueous humor formation in the eye 1, 2
• It is specifically indicated for the management of primary open-angle glaucoma and ocular hypertension, not for systemic hypertension 1

Recommended Antihypertensive Medications

For blood pressure management, current guidelines recommend the following medications:

For Non-Black Patients:

• First-line: Low dose ACE inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) 3
• Second-line: Increase to full dose of initial medication 3
• Third-line: Add thiazide or thiazide-like diuretic 3
• Fourth-line: Add spironolactone or alternatives like amiloride, doxazosin, eplerenone, clonidine or beta-blocker if not tolerated 3

For Black Patients:

• First-line: Low dose ARB or dihydropyridine calcium channel blocker (DHP-CCB) or combination with thiazide/thiazide-like diuretic 3
• Second-line: Increase to full dose 3
• Third-line: Add diuretic or ACE inhibitor/ARB 3
• Fourth-line: Add spironolactone or alternatives as with non-black patients 3

Blood Pressure Treatment Targets

• Target blood pressure should be <130/80 mmHg for most patients 3
• For elderly patients, targets should be individualized based on frailty 3
• Initial goal should be to reduce BP by at least 20/10 mmHg 3

Monitoring Recommendations

• Blood pressure control should be assessed within 3 months of starting therapy 3
• Use validated automated upper arm cuff device with appropriate cuff size 3
• At first visit, measure BP in both arms and use the arm with higher readings for subsequent measurements 3

Special Considerations

• For stage 2 hypertension (BP >20/10 mmHg above target), initiation with two first-line agents from different classes is recommended 3
• For stage 1 hypertension with BP goal <130/80 mmHg, starting with a single agent is reasonable 3
• Consider monotherapy in low-risk grade 1 hypertension and in patients >80 years or frail 3
• Simplify regimen with once daily dosing and single pill combinations when possible 3

Common Pitfalls to Avoid

• Using medications not indicated for hypertension (like Brinsupri) instead of evidence-based antihypertensive drugs 1, 2
• Failing to adjust therapy if blood pressure targets are not achieved within 3 months 3
• Not considering patient-specific factors such as race, age, and comorbidities when selecting antihypertensive medications 3
• Overlooking compelling indications or contraindications for specific drug classes 3
• Not referring patients with uncontrolled hypertension to specialists with expertise in hypertension management 3