Primary aldosteronism - the cardiologist's simplistic approach

September 7, 2019 Andrew To

Screening for secondary causes of hypertension is important, though often not thought of. Primary aldosteronism is the most common endocrine cause. The screening test is the aldosterone-renin ratio (ARR).

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

Nocturnal hypertension

April 20, 2018 Andrew To

65M presented for a general health check, asymptomatic on systems enquiries. BP was 150/90mmHg with no other abnormalities. You decided to send him for an ambulatory blood pressure monitor to establish if more aggressive intervention is necessary. The report states that he is not a nocturnal dipper. His average diurnal BP was 145/85mmHg. Would medications be necessary? Is there anything else we should consider?

Lifestyle changes for hypertension – exactly how effective is it?!

April 19, 2018 Andrew To

In general practice (and in secondary care), we discuss at length lifestyle modifications that aid blood pressure lowering. But exactly how effective are the various strategies?

There are 5 things we could do to reduce our blood pressure, without medications.

Atrial fibrillation – is there a role for lifestyle modification?

February 9, 2018 Andrew To

Chocolate, camote, coconut @ Topolobampo, Chicago, IL

55M presented with first episode of paroxysmal atrial fibrillation proven on resting ECG in the GP practice. Echocardiogram showed structurally normal heart. The cardiologist decided to manage conservatively without starting anti-arrhythmics right now. Which of the following risk factor management should be part of his AF treatment and prevention?

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.

“My cholesterol is almost normal – why do I need statins, doctor?”

January 31, 2018 Andrew To

Baja hiramasa yellowtail, pineapple two ways, achiote infused agave @Topolobampo, Chicago, IL

Traditionally, we are taught that laboratory tests have “normal ranges”, such as in haemoglobin or creatinine. However, this concept of “normal”, when applied in cholesterol measurement, often creates confusion amongst some clinicians and certainly in most patients.