Heart failure medications - dosages

February 17, 2024 Andrew To

Iris Iris Iris by Dane Mitchell @ Auckland Art Gallery 2019

Heart failure medications save lives.

Dosages are important though, and many patients may not be on sufficient dosages.

Here are a number of tables useful for references, adapted from ACC/AHA guidelines 2013.

What should I do with heart failure with preserved ejection fraction?

September 7, 2019 Andrew To

HFpEF stands for heart failure with preserved ejection fraction. Commonly, it is defined as those with an LV ejection fraction of more than 50%, though varying definitions do exist.

This condition is poorly understood and is difficult to diagnose, because it is largely one of excluding other potential non cardiac causes of symptoms suggestive of HF.

Hypertension treatment – how should we choose?

September 6, 2019 Andrew To

Billy Apple @ Auckland Art Gallery 2015 (2 Minutes 33 Seconds (Red))

First line agents for hypertension are one of three classes:

- ACE inhibitors or Angiotensin receptor blockers

- Thiazides

- Calcium channel blockers

Drug preference is mainly influenced by co-morbidities and contraindications, rather than a simple age cut-off.

Beta-blockers in Hypertension

September 5, 2019 Andrew To

70-year-old asymptomatic man with hypertension but not cardiovascular disease presented for a routine check. His pulse rate was 40bpm. His son, aged 45, recently had an MI in Australia.

His medications include

Doxazosin 8mg OD
Metoprolol 95mg CR OD – since 2006
Cilazapril 5mg / Hydrochlorothiazide 12.5mg OD

ECG shows sinus bradycardia, with normal PR interval, QRS duration.

BP therapy initiation - Combination vs. Single Agent

September 4, 2019 Andrew To

Expected BP lowering with different anti-hypertensive classes and dosages.

65M with Type 2 diabetes on oral hypoglycaemics but no proven coronary artery disease, BP 150/95mmHg despite 3 months of intensive lifestyle modifications, not currently on anti-hypertensives. Would you?

- Introduce low dose ACE inhibitors, with gradual up-titration

- Introduce combination ACE inhibitor / thiazide, with up-titration later on

ACC AHA Hypertension Guidelines 2017 – What’s new?

February 1, 2018 Andrew To

@ AHA Meeting in Anaheim 2017 - taking notes

The ACC/AHA Hypertension Guidelines 2017 was released in the AHA meeting in Anaheim, Californiain November 2017.

While there were a lot of changes, I think it has simplified a lot of the complexities surrounding treatment threshold and goal.