Managing Patients with Hypertension and Heart Failure

1
Managing Patients with Hypertension and Heart
Failure

• HFSA 2010 Recommendations

2
HFSA 2010 Practice GuidelineHypertensionPreserve
d EF

• Recommendation 14.1
• In patients with symptomatic or symptomatic LV
  hypertrophy or LV dysfunction without LV dilation
  (Preserved EF)
• It is recommended that blood pressure be
  optimally treated to lower systolic and usually
  diastolic levels. More than 1 drug may be
  required. Target resting levels should be
  lt130/lt80 mmHg, if tolerated.

Strength of Evidence C
3
HFSA 2010 Practice GuidelineHypertensionAsymptom
atic Low EF

• Recommendation 14.2
• In patients with asymptomatic LV dysfunction with
  LV dilation and a low EF
• Prescription of an ACE inhibitor is
  recommended.
• Dose equivalent to 20 mg daily enalapril
  Strength of Evidence A

4
HFSA 2010 Practice GuidelineHypertensionAsymptom
atic Low EF

• Recommendation 14.3
• In patients with asymptomatic LV dysfunction with
  LV dilation and a low EF
• Addition of a beta blocker is recommended, even
  if blood pressure is controlled.
• Dose equivalent to HF trials
  Strength of Evidence C

5
HFSA 2010 Practice GuidelineHypertensionAsymptom
atic Low EF

• Recommendation 14.4
• In patients with asymptomatic LV dysfunction with
  LV dilation and a low EF
• If BP remains gt130/80 mmHg then the addition of a
  thiazide diuretic is recommended, followed by a
  dihydropyridine calcium antagonist (amlodipine or
  felodipine) or other antihypertensive drugs.

Strength of Evidence C
6
HFSA 2010 Practice GuidelineHypertensionSymptoma
tic Low EF

• Recommendation 14.5
• In patients with symptomatic LV dysfunction with
  LV dilation and a low EF
• Prescription of target doses of ACE inhibitors,
  ARBs, beta blockers, aldosterone inhibitors and
  isosorbide dinitrate/hydralazine in various
  combinations (with a diuretic if needed)
  is recommended, based on doses used in
  large-scale outcome trials.

Strength of Evidence A
7
HFSA 2010 Practice GuidelineHypertensionSymptoma
tic Low EF

• Recommendation 14.6
• In patients with symptomatic LV dysfunction with
  LV dilation and a low EF
• If blood pressure remains gt130/80 mmHg, a
  dihydropyridine calcium antagonist (e.g.
  amlodipine or felodipine) may be considered or
  other antihypertensive medication doses
  increased. Strength of Evidence
  C