Cardiovascular
Cardiovascular diseases (CVD) include disorders affecting the heart and blood
vessels such as hypertension, coronary heart disease, heart failure, arrhythmias and
thromboembolic disorders. These conditions are a major cause of morbidity and
mortality worldwide.
Hypertension
Definition and Staging
Hypertension is persistently elevated blood pressure.
Stage 1 Hypertension
Clinic BP ≥ 140/90 mmHg
ABPM/HBPM ≥ 135/85 mmHg
Treatment recommended if:
Target organ damage
Cardiovascular disease
Diabetes
Renal disease
10-year CVD risk ≥10%
Stage 2 Hypertension
Clinic BP ≥ 160/100 mmHg
ABPM/HBPM ≥ 150/95 mmHg
Treatment recommended for all patients.
Stage 3 (Severe Hypertension)
Clinic BP ≥ 180/120 mmHg
Requires urgent treatment.
© KRM
,Blood Pressure Targets
Patients <80 years
≤140/90 mmHg
Patients with target organ damage
≤130/80 mmHg
Patients >80 years
≤150/90 mmHg
Stepwise Drug Treatment
Patients <55 years
Step 1
ACE inhibitor or ARB
Step 2
Add calcium channel blocker (CCB)
Step 3
Add thiazide-like diuretic
Step 4 (resistant hypertension)
Low-dose spironolactone
Alternative options:
Alpha blocker
Beta blocker
Patients ≥55 years or Black African/Caribbean origin
Step 1
Calcium channel blocker
Step 2
Add ACE inhibitor or ARB
Step 3
Add thiazide-like diuretic
Step 4
Low-dose spironolactone
© KRM
,Hypertension in Diabetes
First-line treatment: ACE inhibitor
Hypertension in Pregnancy
First line: Labetalol
Alternatives:
Nifedipine (modified release)
Methyldopa
Methyldopa should be stopped within 2 days after birth.
Target BP after delivery:
<140/90 mmHg
ACE Inhibitors
Examples:
Ramipril
Enalapril
Lisinopril
Captopril
Mechanism
Inhibit angiotensin-converting enzyme, preventing conversion of angiotensin I to
angiotensin II.
This causes:
Vasodilation
Reduced blood pressure
Reduced aldosterone secretion.
Indications
Hypertension
Heart failure
Diabetic nephropathy
Post-myocardial infarction
© KRM
, Side Effects
Dry cough
Hyperkalaemia
Angioedema
Hypotension
Renal impairment
Taste disturbances
Interactions
Lithium → increased risk of lithium toxicity.
Counselling Points
First dose often taken at bedtime
Monitor renal function and potassium levels
Avoid in pregnancy.
Angiotensin II Receptor Blockers (ARBs)
Examples:
Losartan
Candesartan
Valsartan
Used when ACE inhibitors are not tolerated.
Advantages:
Less likely to cause dry cough.
Avoid in:
Pregnancy
Breastfeeding.
Calcium Channel Blockers (CCBs)
Dihydropyridines
Examples:
Amlodipine
Nifedipine
Felodipine
© KRM
Cardiovascular diseases (CVD) include disorders affecting the heart and blood
vessels such as hypertension, coronary heart disease, heart failure, arrhythmias and
thromboembolic disorders. These conditions are a major cause of morbidity and
mortality worldwide.
Hypertension
Definition and Staging
Hypertension is persistently elevated blood pressure.
Stage 1 Hypertension
Clinic BP ≥ 140/90 mmHg
ABPM/HBPM ≥ 135/85 mmHg
Treatment recommended if:
Target organ damage
Cardiovascular disease
Diabetes
Renal disease
10-year CVD risk ≥10%
Stage 2 Hypertension
Clinic BP ≥ 160/100 mmHg
ABPM/HBPM ≥ 150/95 mmHg
Treatment recommended for all patients.
Stage 3 (Severe Hypertension)
Clinic BP ≥ 180/120 mmHg
Requires urgent treatment.
© KRM
,Blood Pressure Targets
Patients <80 years
≤140/90 mmHg
Patients with target organ damage
≤130/80 mmHg
Patients >80 years
≤150/90 mmHg
Stepwise Drug Treatment
Patients <55 years
Step 1
ACE inhibitor or ARB
Step 2
Add calcium channel blocker (CCB)
Step 3
Add thiazide-like diuretic
Step 4 (resistant hypertension)
Low-dose spironolactone
Alternative options:
Alpha blocker
Beta blocker
Patients ≥55 years or Black African/Caribbean origin
Step 1
Calcium channel blocker
Step 2
Add ACE inhibitor or ARB
Step 3
Add thiazide-like diuretic
Step 4
Low-dose spironolactone
© KRM
,Hypertension in Diabetes
First-line treatment: ACE inhibitor
Hypertension in Pregnancy
First line: Labetalol
Alternatives:
Nifedipine (modified release)
Methyldopa
Methyldopa should be stopped within 2 days after birth.
Target BP after delivery:
<140/90 mmHg
ACE Inhibitors
Examples:
Ramipril
Enalapril
Lisinopril
Captopril
Mechanism
Inhibit angiotensin-converting enzyme, preventing conversion of angiotensin I to
angiotensin II.
This causes:
Vasodilation
Reduced blood pressure
Reduced aldosterone secretion.
Indications
Hypertension
Heart failure
Diabetic nephropathy
Post-myocardial infarction
© KRM
, Side Effects
Dry cough
Hyperkalaemia
Angioedema
Hypotension
Renal impairment
Taste disturbances
Interactions
Lithium → increased risk of lithium toxicity.
Counselling Points
First dose often taken at bedtime
Monitor renal function and potassium levels
Avoid in pregnancy.
Angiotensin II Receptor Blockers (ARBs)
Examples:
Losartan
Candesartan
Valsartan
Used when ACE inhibitors are not tolerated.
Advantages:
Less likely to cause dry cough.
Avoid in:
Pregnancy
Breastfeeding.
Calcium Channel Blockers (CCBs)
Dihydropyridines
Examples:
Amlodipine
Nifedipine
Felodipine
© KRM
