Hypertension mainstays
Name the 3 classes of antihypertensive agents that are recommended first line for HTN
ACEi/ARB, thiazide diuretics, calcium channel blockers
Name 1-2 beta blockers with alpha and beta blocking activity.
carvedilol and labetolol
This classification system is used to classify heart failure symptoms based on level of activity
NYHA
These 3 beta blockers are indicated for treatment of HFrEF
bisoprolol, metoprolol succinate, carvedilol
loop diuretics
This class of antihypertensive agent may precipitate gout
Thiazide diuretics
This medication shows benefit in those with resistant hypertension
spironolactone
Gold standard diagnostic exam for diagnosing heart failure
echocardiogram
This guidelines recommend a switch to the following agent for symptomatic patients with class II to III HFrEF who are tolerating ACEi/ARB
Sacubitril/valsartan
This relatively new class of medication has shown the most promising evidence for composite hospitalization/mortality benefit in HFpEF
SGLT2 inhibitors
Name 2 contraindications to ACEi
Pregnancy, bilateral renal artery stenosis, angioedema
This medication is avoided in doses >200 mg/day due to increased risk of lupus like reaction
Hydralazine
Name the LVEF that classifies HFrEF and HFpEF
HFrEF - LVEF </=40%
HFpEF - LVEF >/= 50%
Name the 4 medication classes that provide mortality and morbidity benefit in HFrEF.
ACEi/ARB/ARNI, beta blockers, MRAs, and SGLT2 inhibitors
These two disease states are recommended to be controlled in patients with HFpEF
atrial fibrillation, HTN
DHP calcium channel blockers improve blood pressure. What is another cardiovascular symptoms they may improve.
angina
This is the definition of resistant hypertension
3+ antihypertensive agents
This stage of heart failure is classified by those with marked HF symptoms that interfere with daily life and recurrent hospitalization despite attempts to optimize GDMT
Stage D
PCP wants to switch to sacubitril/valsartan. What dose of sacubitril/valsartan do you recommended for a patient who is on lisinopril 40 mg daily.
49/51 mg BID
In the TOPCAT trial, this medication was found to have benefit in treatment of HFpEF in a post hoc analysis that analyzed the results by geographic region.
Spironolactone
If a SCr increases by ___ percent, consider dose reduction or discontinuation of ACEi/ARB.
30%
Name 4 counseling points for proper BP technique
No talking
Rest for 5 min
30 min to 1 hr free of caffeinie/nicotine
Feet flat on floor
Preferably 1-2 hours after morning medications
This lab values may be elevated in those on sacubitril/valsartan
BNP
Name a new device that is placed in the pulmonary artery that allows clinicians to assess patient's fluid status for HF
Cardiomems
Name the equivalent doses of torsemide and bumetanide that are equal to furosemide 40 mg daily.
Torsemide 20 mg
Bumetanide 1 mg