Cardiovascular Flashcards
(16 cards)
CHA2DS2-Vasc
CHF history
Hypertension
Age (+1 65-74, +2 if 75+)
2
Diabetes
Stoke/TIA/VTE
2
Vascular history - MI, PVD, aortic plaque
Immediate initiation of antihypertensive (and lifestyle), regardless of 5-year CVD risk
≥ 160/100
Hypertension and CVD risk <5%
Lifestyle changes
Hypertension and CVD risk 5-15%
consider meds if BP >140/90
Hypertension and risk >15%
antihypertensive
When is low dose monotherapy with ACEi/ARB appropriate for treating hypertension?
Age 80%+
Frail
Within 20/10 of target
Committing to major lifestyle change
Give an example of 2 low dose antihypertensives that could be used to start BP treatment
Losartan 50mg
Candesartan 4mg
Quinapril 10mg
Enalapril 5mg
+
Amlodipine 5mg
Felodipine 5mg
Follow up required for ACEi/ARB
Pre-screening + renal function, YEC, BP, risk of low BP
1-2 weeks after dose adjustments then minimum anually
When should an ACEi/ARB be stopped?
Cr increases by > 30%
eGFR decreases by > 25%
Serum potassium above the upper limit of normal
–> investigate cause including concomitant medications; consider stopping or reducing dose of ACE inhibitor; discontinue if serum potassium is greater than 5.9 mmol/L.
What is the 3rd antihypertensive of choice after ACEi/ARB + CCB
Thiazide diuretic
Hydrochlorothiazide + losartan
50 + 12.5
OR
Hydrochlorthiazide + candesartan
16+12.5 or 32+12.5 or 32+25
OR
Bendroflumethiazide 2.5mg
Thiazide MOA
Moderately potent diuretics.
Inhibit reabsorption of Na and Cl in DCT (so water remains in DCT) which increases K excretion
If target not achieved with 3 BP meds
Increase doses
24h monitoring
Secondary causes/adherence
Add spironolactone (or BB or AB)
–> Refer medicine
BP monitoring during medicine titration
Every 4-6 weeks during medicine titration
BP target for high risk CVD
(current atherosclerotic heart disease, HF, diabetes, CKD, age >65, CvD risk >15%)
<130/80 in clinic
BP target for low risk CVD
<140/90
B1 selective BBs
Bisoprolol
Metoprolol
