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.