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Managing Patients with Hypertension and Heart Failure

Managing Patients with Hypertension and Heart Failure. HFSA 2010 Recommendations. HFSA 2010 Practice Guideline Hypertension—Preserved EF. Recommendation 14.1 In patients with symptomatic or symptomatic LV hypertrophy or LV dysfunction without LV dilation ( Preserved EF ):

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Managing Patients with Hypertension and Heart Failure

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  1. Managing Patients with Hypertension and Heart Failure HFSA 2010 Recommendations

  2. HFSA 2010 Practice GuidelineHypertension—Preserved EF • Recommendation 14.1 • In patients with symptomatic or symptomatic LV hypertrophy or LV dysfunction without LV dilation (Preserved EF): • It is recommended that blood pressure be optimally treated to lower systolic and usually diastolic levels. More than 1 drug may be required. Target resting levels should be <130/<80 mmHg, if tolerated. Strength of Evidence = C

  3. HFSA 2010 Practice GuidelineHypertension—Asymptomatic Low EF • Recommendation 14.2 • In patients with asymptomatic LV dysfunction with LV dilation and a low EF: • Prescription of an ACE inhibitor is recommended. • Dose equivalent to 20 mg daily enalapril Strength of Evidence = A

  4. HFSA 2010 Practice GuidelineHypertension—Asymptomatic Low EF • Recommendation 14.3 • In patients with asymptomatic LV dysfunction with LV dilation and a low EF: • Addition of a beta blocker is recommended, even if blood pressure is controlled. • Dose equivalent to HF trialsStrength of Evidence = C

  5. HFSA 2010 Practice GuidelineHypertension—Asymptomatic Low EF • Recommendation 14.4 • In patients with asymptomatic LV dysfunction with LV dilation and a low EF: • If BP remains >130/80 mmHg then the addition of a thiazide diuretic is recommended, followed by a dihydropyridine calcium antagonist (amlodipine or felodipine) or other antihypertensive drugs. Strength of Evidence = C

  6. HFSA 2010 Practice GuidelineHypertension—Symptomatic Low EF • Recommendation 14.5 • In patients with symptomatic LV dysfunction with LV dilation and a low EF: • Prescription of target doses of ACE inhibitors, ARBs, beta blockers, aldosterone inhibitors and isosorbide dinitrate/hydralazine in various combinations (with a diuretic if needed) is recommended, based on doses used in large-scale outcome trials. Strength of Evidence = A

  7. HFSA 2010 Practice GuidelineHypertension—Symptomatic Low EF • Recommendation 14.6 • In patients with symptomatic LV dysfunction with LV dilation and a low EF: • If blood pressure remains >130/80 mmHg, a dihydropyridine calcium antagonist (e.g. amlodipine or felodipine) may be considered or other antihypertensive medication doses increased. Strength of Evidence = C

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