FITZ: CV
Low intensity
(not recommended) LDL decrease less than 30 Pravastatin 10-20 Lovastatin 20mg
Omega-3 fatty acid
4g/d dose (1 lb of salmon) ↓ TG up to 30% Increase HDL slightly
HLD tx recs for 10-year ASCVD risk of 7.5% or more and age 40 to 75 years
: moderate- to high-intensity statin
Stage C tx
ACE, BB, Diuretic
Enhanced Potassium intake
Aim for 3500-500 mg/d preferably by consumption of a diet high in potassium (mango and orange) -4mmHg -2mmHg
What medication is not safe for pregnancy HTN
Do NOT use during PREGNANCY- ACE
Suspected Heart failure: symptoms
Dyspnea Fatigue Edmea
Low Na intake
Further reduction of sodium intake to 1500 mg/day is desirable because it is associated with an even greater reduction in BP Reduce intake by at least 1000 mg/day because that will lower BP, even if the desired daily sodium intake is not yet achieved -5mmHg -2mmHg
HyperTG levels
Mild: 150-199 Moderate: 200-299 (CVD risk) Severe: 1000-1999 Very Severe: 2000 (risk for pancreatitis)
*BB decares and HF
risk of sudden cardiac death
HF history
1.Clincal history Previous MI/ ACE Angina HTN Valvular dx or rheumatic fever palpitations
what HTN medication to avoi in HF
Calcium channel blockers
Statin drug to drug
Caution with concomitant use of grapefruit juice (CY450 inhibitor) with the use of simvastatin, atorvastatin, lovastatin
Grade 2:
Common in long-standing poorly controlled HTN, reversible Narrowing of arterioles with severe local constriction No vision changes or permanent findings
Grade 1:
Common in long-standing poorly controlled HTN, reversible Narrowing of terminal arteriolar branches No vision changes or permanent findingsgs
Calcium channel blockers examples
Dihydropyridine (DHP) examples: Amlodipine, -ipine Non DHP examples: Diltiazem
Which of the following classes of antihypertensive medications is least affected by the use of NSAIDs? ACE inhibitors Beta blockers Calcium channel blockers ARBs
FeedbackCorrect answer is: Calcium channel blockers. The use of NSAIDs can increase mean arterial pressure by ~5 mm Hg. In a dose-dependent manner, these agents can also reverse the effects of several types of antihypertensive medications, including beta-blockers (most potent), diuretics, ACEIs and ARBs. However, NSAIDs do not have an effect on calcium channel blockers. Other impacts of NSAIDs in the elderly include renal impairment, sodium retention, decreased GFR, edema, hyperkalemia, and/or papillary necrosis
Aldosterone and K
HyperKalcemia risks, particular with ACE/ARB, volume depletion, diuresis
Evaluate/ treat for common causes of secondary y
HypertTG DM, poorly controlled Untreated hypothyroid Medications: Second generation antipsychotics, systemic corticosteroids, system estrogen supplements, systemic retinoid Lifestyle High carb, ETOH, sedentary lifestyle, obesit
Kidney
Hypertensive nephropathy, renal failure
Eye
Hypertensive retinopathy with risk for blindness Hypertensive Retinopathy: only part of the body you can see the damage; if there is damage here there is damage everywhere
BP Goals
JNC-8: <140/<90 for nearly all AHA/ACC = <130/<80 for nearly all
Weight reduction
Maintain /Lose weight. Each Kg = -1mmHg
Aldosterone antagonist example
Spironolactone, eplerenone
Stage A HF
at risk for HF (due to HTn, Atherosclerosis, DM, obestiy, metabolic syndrome) but no structural dx of s/s
HLD: what percentage of diet is fat
reduce to 25-35% of total daily caloric intake
HMg-CoA reductase inhibitor (statin)
#1 EBP ↓ LDL as much as 50% Increase HDL slightly ↓ TG slightly Check hepatic enzymes prior to initiation to establish baseline only. No further routine hepatic enzymes monitoring warranted
High-Intensity Statin Therapy
(Avised with higher risk for statin adverse effects, including age >75, imparied renal function, frailty multiple comorbidities, with fibrate) LDL Decrease 50% Atorvastatin 40-80 Rosuvastatin 20-40
Moderate intensity
(Good if high risk for side effects) LDL decrease 30-49 Atorvastatin 10-20 Rosuvastatin 5-10 Simvastatin 20-40 Pravastatin 40-80 Lovastatin 40mg
The use of niacin for treatment of dyslipidemia is not recommended due to: High risk of severe life-threatening adverse effects. Increased risk of hypertriglyceridemia. A general lack of evidence supporting its use in improving cardiovascular outcomes. A contraindication when used concomitantly with a statin
. FeedbackCorrect answer is: A general lack of evidence supporting its use in improving cardiovascular outcomes. Clinical evidence supports the use of statins are the preferred first-line treatment for reduction of LDL-C and improving cardiovascular outcomes. Niacin is no longer recommended for LDL-C reduction as there is a general lack of clinical evidence demonstrating improved cardiovascular outcomes. Though niacin is associated with certain adverse effects (e.g., flushing, upper GI distress), life-threatening adverse events are rare. Niacin can be effective in reducing triglyceride levels, increasing HDL-C, and its use is not contraindicated when used with a statin.
t. For cases of recurrent stroke prevention, ACCF/AHA recommends the use of
ACEI, ARB, calcium channel blocker, or a thiazide diuretic.
Risks for ACE angioedema
ACEI- induced angioedema is less than a 1% risk Risks: NSAID allergy, Black, Latinx
Frist line for BLack patients HTN
According to JNC-8, the drug classes of choice for the management of hypertension among adults of African ancestry are a thiazide-type diuretic (e.g., chlorthalidone) or a calcium channel blocker. ACC/AHA guidelines also give preference to thiazide diuretics and calcium channel blockers as first-line agents for adults
Statin SE
Adverse effects: Rhabdomyolysis, myosotis, rare but often noted with high statin dose with risk factors
omega-3 fatty acid SE
Adverse effects: increased risk of bleeding (anti-platelet) GI upset / fishy taste (can freeze capsules, take with food, avoid hot beverages immediately after)
CVD risk estimator calculator:
Age, gender, race, total cholesterol, HDL, SBP, DBP, BP meds, DM, Smoker
HTN Urgency
Asymptomatic elevated BP Severe HTN: over 180/120 Patient is stable without acute or impending change in HTN target organ dysfunction NO need for ED or immediate office BP reduction of medications (nitro, clonidine, hydralazine) Increase or restater medications (commonly found in patient who stop taking meds)
Beta-Blockers exmplea
Atenolol, metoprolol, propranolol
Beta-Blockers
Atenolol, metoprolol, propranolol BP = ↓HR * ↓SV *PVR Not first line Avoid non cardioselective BB (propranolol nadolol) in lower RES dx patients Lower dose cardio selective beta blocker therapy usually acceptable in COPD, Asthma
Cardio
Atherosclerosis, myocardial infarction, left ventricular hypertrophy, heart failure
ACE- inhibitor deets
BP = HR * SV *PVR↓ K=sparing, hyperkalemia risk with inadequate fluid intake overdiuresis, renal impairment, when used with aldosterone antagonist ACEI- induced cough, use ARB ACEI- induced angioedema is less than a 1% risk Risks: NSAID allergy, Black, Latinx Per ADA, #1 med for DM Do NOT use during PREGNANCY
Thiazide Diuretic deets
BP = HR * SV *PVR↓ Na, K, Mg depleting Calcium sparing Lower observed rate of fractures in women who are long term thiazide Less effective with GFR less than 30 (Loop diuretics remain effect and can be used in low GFR pt)
what HTN to avoid in renal or hepatic issues
Calcium channel blockers
Diet
Consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts; and limits intake of sweets, sugar-sweetened beverages, and red meats (e.g., D-ASH dietary pattern) -11 -3mmHg
Calcium channel blockers
Dihydropyridine (DHP) examples: Amlodipine, -ipine Non DHP examples: Diltiazem BP = HR * SV *PVR↓ Ankle edema, particular with DHP use, usually dose dependent, with more edema higher doses (due to vasodilation) not always HF Avoid use or use with caution in presence of heart failure, renal or hepatic involvement
Seek Evidence of underlying heart disease Investigation directed by clinical presentation
EKG CXR Echo Hbg CMP TSH
Proprotein convertase subtilisin Kexin type 9 (PCSK9)
Evolocomab (-mab) ↓ LDL 60% ( for patients already on statin therapy) SC injection Used as add on for statin therapy or familial HLD when LDL cant be met with other meds
Thiazide Diuretic
Examples: HCTZ, chlorthalidone
Selective Cholesterol absorption inhibitor
Ezetimibe (zetia) ↓ LDL up to 20% Increase HDL slightly Adverse effects: Few due to limited systemic absorption When combined with simvastatin, drug combination known as Vytorin
HTN Additional test
Fasting blood glucose, CBC, lipid, serum Cr and GFR, Na, K Ca, TSH, Urinalysis, EKG- look for chamber enlargement Options: Echo, uric acid, urinary albumin: cr ratio Start meds and recheck in 1 month
You see a 62-year-old male with COPD who is scheduled for a follow-up on recent hospitalization for COPD exacerbation. As he ambulates into the exam room, he begins to stagger, perspires profusely, and complains of generalized pain and a tightening feeling in his chest. The most appropriate action is to: Have him lie down with feet elevated for 10 minutes before resuming the test. Obtain an ECG to detect heart rhythm abnormalities. Immediately initiate oxygen therapy. Administer nitroglycerin and call 911 to activate emergency medical services.
FeedbackCorrect answer is: Administer nitroglycerin and call 911 to activate emergency medical service
Which of the following statements is accurate regarding the use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB)? These agents should be used with caution in patients with diabetes mellitus. Dose adjustment is not necessary in the presence of renal insufficiency. Avoid the use of these agents in the presence of bilateral renal artery stenosis. Hyperkalemia risk can be diminished with concomitant use of an aldosterone antagonist.
FeedbackCorrect answer is: Avoid the use of these agents in the presence of bilateral renal artery stenosis. Angiotensin II (Ag II) is a potent vasoconstrictor that stimulates adrenal catecholamine release. ACEI reduces blood pressure by minimizing the production of Ag II, while ARB blocks the action of Ag II. Dose adjustment of these agents is needed in the presence of renal insufficiency. These agents confer renal protection in patients with diabetes mellitus and they should be avoided in the presence of bilateral renal artery stenosis. The use of these agents is also associated with hyperkalemia risk, especially with concomitant use of an aldosterone antagonis
Which of the following antihypertensive medications should be used with caution in elderly patients with renal impairment due to increased risk of peripheral edema and postural hypotension? ACE inhibitor Angiotensin receptor blocker Calcium channel blocker Beta blocker
FeedbackCorrect answer is: Calcium channel blocker. Calcium channel blockers, such as amlodipine, diltiazem and verapamil, reduce blood pressure through vasodilation. These agents are particularly well suited in treating hypertensive patients with arterial stiffness, decreased vascular compliance, and diastolic dysfunction. However, these agents should be used with caution in patients, especially in older adults, with heart failure or renal or hepatic impairment. The most common adverse effects are related to its vasodilation properties, and include ankle edema, headache, and postural hypotension with resulting lightheaded sensation, particularly with position chang
All of the following are recommended practices for obtaining an accurate blood pressure measurement except: At least 2 measurements should be performed at each visit. Blood pressure cuff should be at heart level. Patient should be seated for at least 5 minutes prior to measurement. Feet should be slightly elevated on a small stool during the measurement.
FeedbackCorrect answer is: Feet should be slightly elevated on a small stool during the measurement. Diagnosis and treatment of hypertension depend on accurate measurement of auscultatory blood pressure. When measuring blood pressure, the patient should be seated comfortably for at least 5 minutes with back supported, legs uncrossed and feet on the floor. Crossing the legs can increase systolic pressure. The patient's arm should be supported in a horizontal position. If the arm is unsupported and held up by the patient, the pressure will be higher. Neither the patient nor the person taking the measurement should talk during the procedure since talking can cause deviations in the measurement. The blood pressure cuff should be placed at heart level. At least 2 blood pressure measurements per visit are recommended.
Which of the following treatment-related adverse effects is not generally associated with the use of antihypertensive medications in the elderly? Gastrointestinal upset Electrolyte disturbances Renal dysfunction Excessive orthostatic blood pressure decline
FeedbackCorrect answer is: Gastrointestinal upset. When managing hypertension in the elderly, healthcare providers must be cognizant of the prevalence of cardiovascular and non-cardiovascular comorbidities in this patient population. These conditions, along with the use of concomitant medications, can increase the risk of treatment-related adverse effects associated with antihypertensive medications. The most common treatment-related adverse effects of antihypertensive medications include electrolyte disturbances (e.g., hyperkalemia and hyponatremia), renal dysfunction, and excessive orthostatic blood pressure decline.
A potential adverse effect seen with aldosterone antagonist use in the elderly is: Hypernatremia. Hypokalemia. Hypercalcemia. Hyperkalemia.
FeedbackCorrect answer is: Hyperkalemia. Aldosterone antagonists, such as spironolactone and eplerenone, block the effects of aldosterone and, therefore, improve regulation of sodium and water homeostasis as well as improve maintenance of intravascular volume. However, the use of these agents is associated with an increased risk of hyperkalemia, particularly in the elderly as well as with concomitant use of ACEIs or ARBs. Aldosterone antagonists should also be used with caution in the presence of renal impairment.
In counseling a patient about dietary selections to reduce LDL-C, you recommend which of the following meal choices? Garden salad with ranch dressing Rotisserie chicken Oatmeal Whole wheat pasta with white (alfredo) sauce
FeedbackCorrect answer is: Oatmeal. Diet can significantly impact blood cholesterol levels as foods high in saturated fat can lead to higher LDL-C. Saturated fats are found in greatest amounts in foods from animals (such as fatty cuts of meat and poultry with the skin), whole-milk dairy products, lard, and some vegetable oils (e.g., coconut and palm oils). Soluble fiber, as found in oatmeal, dissolves into a gel-like substance in the intestines and blocks cholesterol and fats from being absorbed. Research has shown that increasing soluble fiber intake by 5-10 grams per day can decrease LDL-C by 5%. Wheat products, including whole wheat products, do not lower LDL-C levels like oat-containing products.
Risk factors for rhabdomyolysis and myositis with the use of high doses of statin medications include all of the following except: Obesity. Advanced age. Renal impairment. Low body weight.
FeedbackCorrect answer is: Obesity. Rhabdomyolysis and myositis are rare adverse effects associated with statin use and are most often noted when high doses are used. Certain factors that can increase the risk of these adverse events include use in combination with a fibrate, in the presence of renal impairment, multiple comorbidities, low body weight, and advanced age.
Max is a 57-year-old man who was diagnosed two days ago with acute viral pericarditis. He was started on ibuprofen 600 mg PO QID. Today he returns to the clinic complaining that the pain is still intense and he has little relief with the ibuprofen. As a result, he called out sick from his job yesterday. The most appropriate response would be to: Order a 12-lead ECG to confirm the diagnosis. Consider initiating opioid analgesia. Consider echocardiography. Order a short course of systemic oral corticosteroid.
FeedbackCorrect answer is: Order a short course of systemic oral corticosteroid. Viral pericarditis, the most common type of pericarditis, is an acute viral inflammation of the pericardium and, in most cases, responds well to nonsteroidal anti-inflammatory drugs. However, occasionally the inflammation is refractory and a short course of oral systemic corticosteroids is indicated for pain relief. Opiate analgesia is typically not required, and presuming a definitive diagnosis, further diagnostic evaluation is not indicated when symptoms present for only two days. If the prednisone does not provide relief, or symptoms persist for several days, then a more aggressive diagnostic evaluation is appropriate
Mrs. Jones is a 58-year-old female recently diagnosed with acute bacterial endocarditis following a surgical procedure. She was managed with intravenous antibiotic therapy while in hospital and is being seen in follow-up. When evaluating Mrs. Jones today, which of the following physical findings would the nurse practitioner anticipate with resolution of the infection? Resolution of a blowing systolic murmur The presence of Osler's nodes Subungual hemorrhages Convex ST elevations in the lateral leads on 12-lead ECG
FeedbackCorrect answer is: Resolution of a blowing systolic murmur. Successful management of bacterial endocarditis will be characterized by resolution of symptoms and normalization of physical examination findings. Acute bacterial endocarditis is associated with a medium-pitched blowing systolic murmur indicative of mitral regurgitation. A decrease in murmur associated with aortic regurgitation suggests resolving vegetation and less turbulent blood flow through the cardiac valves. Conversely, Osler's nodes, which are dermal accumulations of vegetation in the palms of the hands, suggest active endocarditis. Subungual hemorrhages, which are accumulations of blood beneath the fingernails, also suggest acute infectious endocarditis. Both Osler's nodes and subungual hemorrhages will resolve as infection resolves. ST elevations in the lateral leads are not consistent with endocarditis at any stage; regional ST elevations suggest myocardial insult
Which of the following statements is most accurate regarding the use of a thiazide diuretic in the elderly? The effect of thiazide diuretics is not impacted by renal function. Thiazide diuretic use is an independent risk factor for the development of type 2 diabetes mellitus. Older adults are particularly sensitive to hypernatremia induced by thiazide diuretic use. Thiazide diuretics are contraindicated for those ≥75 years.
FeedbackCorrect answer is: Thiazide diuretic use is an independent risk factor for the development of type 2 diabetes mellitus. Diuretics are considered first-line treatment for uncomplicated hypertension and work through low volume sodium depletion that leads to a reduction in peripheral vascular resistance. Thiazide diuretics are less effective when creatinine level is ≥1.8 mg/dL, though loop diuretics likely remain effective for those patients. High doses of a thiazide diuretic have the potential for a negative impact on dyslipidemia and glucose control, and their use is an independent risk factor for the development of type 2 diabetes mellitus. Elderly patients are particularly sensitive to hyponatremia induced by thiazide diuretic use, in part due to the difficulty the aging kidney has with sodium conservation.
Pharmacology TG
For TG: 199-499 Treat secondary causes Statin For TG over 500 Add omega-3 or fibrate
HLD and what level statin a. 42-year-old with type 2 diabetes mellitus and LDL-C of 120 mg/dL b. 42-year-old with 10-year ASCVD risk of 4% and LDL-C of 120 mg/dL c. 42-year-old with 10-year ASCVD risk of 20% and LDL-C of 120 mg/dL
For individuals with diabetes mellitus and with LDL-C between 70 to 189 mg/dL, the current ACC/AHA guidelines recommend initiating moderate-intensity statin therapy. Examples of moderate-intensity statin therapy include atorvastatin 10-20 mg, rosuvastatin 5-10 mg, simvastatin 20-40 mg, pravastatin 40-80 mg, or lovastatin 40 mg (all daily doses). High-intensity statin therapy is recommended for those with LDL-C ≥190 mg/dL as well as those ages 40‒75 years with LDL-C of 70 to 190 mg/dL and a 10-year ASCVD risk of 20% or higher. High-intensity regimens include atorvastatin 40‒80 mg or rosuvastatin 20‒40 mg daily. For those between 40‒75 years of age with LDL-C of 70 to 190 mg/dL and a 10-year ASCVD risk of 5% or lower, only a risk discussion is needed to emphasize lifestyle modifications to reduce risk factors.
General population and documented CVD omgega three recs
For the general population, a variety of fish at least twice a week. With documented CHD 1g/day is recommended
BP:
HR * SV * PVR PVR increases as you age, stiffer pipes
HF causes
Heart failure occurs when the heart is unable to pump an adequate amount of blood throughout the body, and can lead to dyspnea, fatigue and weakness, edema, and rapid or irregular heartbeat. To compensate, left ventricular hypertrophy (LVH), or an enlargement or thickening of the left ventricle, is often observed. Coronary artery disease is a major risk factor as narrowed arteries can limit the heart's supply of oxygen-rich blood. Other risk factors include hypertension, especially with long-term and poor control, prior history of acute coronary syndrome, diabetes, sleep apnea, and congenital heart defects.
Moderate alcohol
In individuals who drink alcohol, reduce intake to Men <2 drinks daily and women < 1 drink daily -4mmHg -3mmHg
Increase intake of omega-3 fatty acids
Include oils and foods rich in alpha linolenic acid (flaxseed, canola, soybean oils, walnuts) Approximately 1 g of EPA + DHA per day preferably from oily fish EPA + DHA (fish oil) supplement could be used
Fibric acid derivatives (fibrates)
Increase HDL up to 20% ↓ TG up to 50% Slightly decrease LDL Adverse effects: myopathy, increaing rhabdomyolysis particularly if taken with statin
Dietary options to enhance Lowering LDL
Increase intake of viscous or soluble fiber to 10-25 grams per day, plant sterols and stanols to 2 g/ day Viscous or soluble fiber: oatmeal, bran, others Plan stanols: food additive in Take Control, Benecol margarine, othrs
ACE and K
K=sparing, hyperkalemia risk with inadequate fluid intake overdiuresis, renal impairment, when used with aldosterone antagonist
*ICD: and HF
LVH with decreased EF- very high risk for sudden cardiac death
ACE- inhibitor
Lisinopril, enalapril
ARBS
Losartan, telmisartan
HCTZ AND ELECTROLYTES
Na, K, Mg depleting Calcium sparing
Diagnosis of HTN:
Need 2 separate readings
therapy steps
Non-black race, no CKD or DM Initiate thiazide-type diuretic or ACEI or ARB or CCB, alone or in combination. Black race, no DM or CKD Initiate thiazide-type diuretic or CCB, alone or in combination. Any age with CKD, with or without DM Initiate ACEI or ARB, alone or in combination with other drug classes.
Polyunsaturated fat diet soruces
Polyunsaturated fat intake (soybean, corn, and sunflower oil, fatty fish (salmon, mackerel, hering, trout) walnuts, sunflower seed, monounsaturated fats (olive and canola) Avoid tropical oils such as coconut oil
diet: cholesterol reduction
Reduce total cholesterol intake to <200 mg/d and
Aerobic physical activity
Regular aerobic physical activity (e.g., brisk walking) on average 40 min per session, at least 3-4 sessions per week, and involving moderate to vigorous intensity physical activity. Total 90-150min.week -5mmHg -2mmHg
Reduce intake of saturated fat and cholesterol
SAturated fat <7% of total calories Avoid trans fat
HTH Emergency
Severe HTN: over 180/120 Patient has evidence of impending progressive target organ damage: HF, pulmonary edema, retinopathy, intracerebral hemorrhage, encephalopathy, acute stroke, MI, unstable angina pectoris, dissection aortic aneurysm, acute renal failure, eclampsia Immediate transfer to the ED for possible ICU admission Reduce BP by no more than 25% in the first hour
Aldosterone antagonist
Spironolactone, eplerenone BP = HR * SV *PVR↓ Not a first line agent (too many adverse effects) HyperKalcemia risks, particular with ACE/ARB, volume depletion, diuresis Gynecomastia risks with prolonged use (bc anti androgen effects)
In primary care:
Stage A and B is the focus with the goal of avoiding stage C and D if possible. Stages B, C, and D therapy in consultation with cardiology
Brain
Stroke, vascular (multi-infarct) dementia
Stage B HF
Structural heart disease but without signs or symptoms of HF MI LV remodeling Valvular disease
Stage c:
Structural heart disease with prior or current symptoms of HF
Heart failure confirmed by etiology determined
Systemic LV dysfunction (most common) Diastolic LV dysfunction Valve disease Congenital heart ideas Pericardial disease Endocardial disease Rhythm/ conduction disturbance
HF suspected exam
Tachycardia Increased JVP Displaced apex beat S3 heart sound Murmur Pulmonary crackles Dependent edema
What medicine is calcium sparing
Thiazide Diuretic Lower observed rate of fractures in women who are long term thiazide
Grade 3:
Usually when DBP over 110, HTN emergency Preceding sings with flame-shaped hemorrhages Potential for visual changes (black spots in the visual field) & permanent findings
Grade 4:
Usually when DBP over 130, HTN emergency Papilledema (too much pressure in the brain) with preceding signs Potential for visual change and permanent findin
Vascular dementi
a is caused by a series of strokes or mini-strokes that produce focal or diffuse effects on the brain. A characteristic of vascular dementia is a change in mental status at noticeable stages (i.e., following each stroke or mini-stroke event) rather than a gradual, steady decline observed with Alzheimer's dementia.
Stage B HF tx
goal: prevent sx and further dmg drug: ACE/ARB BB (decrease risk of sudden death) sometimes ICD (esp for pt with LVH and low EF)
STAGE A HF tx
heart healthy Prevent vascular coronary disease Prevent LV structural abnormalities ACE/ ARB Statin as needed
HLD tx recs for LDL-C of 190 mg/dL or more:
high-intensity statin (or moderate-intensity statin if not a candidate for high-intensity statin)
HLD tx recs for Clinical ASCVD:
high-intensity statin for age 75 years or younger, or moderate-intensity statin for age over 75 years or if not a candidate for high-intensity statin
Postural hypotension (also known as orthostatic hypotension or orthostasis)
is a form of low blood pressure when a person moves from a sitting or lying down position to a standing position. Normally, baroreceptors near the heart and neck arteries sense the low blood pressure and counteract it by triggering the heart to beat faster and pump more blood. However, this baroreflex function diminishes in older age. Symptoms can include faintness, dizziness, confusion, and light-headedness, and the condition can increase the risk of falls and syncope. Postural hypotension can be detected by comparing the blood pressure while sitting versus standing for 1‒3 minutes. A fall in blood pressure of ≥20 mm Hg systolic and/or ≥10 mm Hg diastolic after standing upright would indicate the presence of postural hypotension.
HLD tx recs for Diabetes (type 1 or 2) and age 40 to 75 years:
moderate-intensity statin (high-intensity statin if 10-year ASCVD risk of 7.5% or more)
stage d heart failure
patients with end-stage disease requiring specialized treatment, such as mechanical circulatory support, procedures to facilitate fluid removal
