Hypertension + Heart Failure - evaluation and management guidelines

Tables of Contents

Hypertension

Incidence and prevalence

Diagnostic criteria for hypertension

Measuring BP

‘White Coat Hypertension

Ambulatory blood pressure monitoring (ABPM)

Prevention of hypertension

Ø      Magnesium intake

Home blood pressure readings

Primary or essential hypertension

Secondary hypertension

Renovascular hypertension

Nocturnal blood pressure levels

Hypertension in diabetes

Hypertension and pregnancy

Hypertension and renal disease

Hypertension and cardiac disease

Hypertension and lead exposure

Echocardiography

Follow-up visits for mild to moderate hypertension

Indications for additional lab or radiologic evaluation

Isolated systolic hypertension

Malignant hypertension

Hypertension definitions – Table I.

Retinopathy

Secondary Hypertension – Table II.

History, etiologic factors

Obesity – Hypertension relationships

Physical and laboratory evaluation

Patient education

Surgery in the hypertensive patient

Therapy - nonpharmacologic

Ø      Stress reduction

Ø      Exercise (update 4-05, 7-05)

Ø      Diet issues including sodium, calcium, potassium, soy, alcohol, folate, other

Ø      Dash diet

Ø      Mediterrean diet

Pharmacologic therapy

Ø      Anti-hypertensive therapy in black patients

Ø      Dual indications for common antihypertensive agents

Ø      Step Therapy

Ø      Common oral antihypertensive drugs by class (table)

Ø      Recommendations from JNC 7

Quality measures – HEDIS, AHA/AMA

Hypertension References and Resources

Scientific references

Patient Resources

Hypertension-related web sites

Heart Failure

Introduction

Symptoms and signs of HF

Staging or classification of HF

Diastolic HF (update 11-06)

Electrocardiogram as a predictor

Emotional stress can precipitate severe acute reversible left ventricular dysfunction

What about alcohol?

Treatment - nonpharmacologic

v      Diet – sodium, Dash diet

v      Biventricular Pacing/Resynchronization - Indications for pacing

v      Exercise training in HF

v      Case Management – comprehensive care to avoid readmissions

Treatment – Pharmacologic (overview)

Contra-indicated drug therapy

Nesiritide, B-Type Natriuretic Peptide, Natrecor ® 

Viagra

Sleep apnea associated with HF

Hospital management: Admission and Discharge Criteria Guidelines

·         Post-discharge care

·         Case management

Quality care for heart failure

v      Clinical Performance Measures

v      Outcome Measures

  Heart Failure References and Resources

·         References

·         Web resources

 

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