By Neil R. Poulter
Here are fast solutions to universal scientific questions in relation to cardiovascular possibility. Taking a guidelines-driven procedure, the writer has simplified the large variety of scientific offerings to be had to the health professional assessing their sufferer for cardiovascular risk.
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Additional resources for Clinical manual of total cardiovascular risk
Glucose ↑ cholesterol and triglyerides ↑ uric acid Impotence Urinary frequency Gout BetaBlockers Good for angina, Good for anxiety, Good for post-MI ↑ triglycerides ↓ HDL cholesterol ↓ cardiac output/exercise tolerance Contraindicated in asthma; caution in CCF and PVD ? Reduced stroke protection Lethargy Raynaud’s phenomenon Sleep disturbance Depression Impotence ACE inhibitors LVH regression ↓ Na+ retention Lipid neutral Renal protection in diabetes Contraindicated in renal artery stenosis and women of child-bearing age Cough Hypotension (with diuretic) All antagonists Well tolerated (no ACE cough) As for ACE inhibitors Hypotension (with diuretic) CCBs Lipid neutral Weak diuretic effect Anti-anginal effect Negative inotropic effect of verapamil and diltiazem Short-acting drugs contraindicated in CHD Flushing Headaches Oedema Alphablockers Improvement in lipid profile and insulin resistance improved sexual potency Improved prostatism Caution in heart failure Palpitations Postural hypotension (with short-acting agents) ACE, angiotensin-converting enzyme; CCBs, calcium-channel blockers; CCF, congestive cardiac failure; DHP, dihydropyridine; HDL, high-density lipoprotein; LVH, left ventricular hypertrophy; MI, myocardial infarction; PVD, peripheral vascular disease.
Reproduced with permission from the JBS 2 guidelines. Heart 2005; 91(Suppl 5):1–52. 2 ESH-ESC Guidelines 2007 of action and having been shown not to produce optimal BP lowering in earlier studies. 5). 3 Advantages, disadvantages, and side effects of drug treatments Treatment Advantages Disadvantages Side-effects Diuretics Low cost Effective in the elderly ↓ K+ leading to arrhythmias ? glucose ↑ cholesterol and triglyerides ↑ uric acid Impotence Urinary frequency Gout BetaBlockers Good for angina, Good for anxiety, Good for post-MI ↑ triglycerides ↓ HDL cholesterol ↓ cardiac output/exercise tolerance Contraindicated in asthma; caution in CCF and PVD ?
It is clear from the extensive meta-analyses produced by the BPLTT ANTIHYPERTENSIVE AGENTS • 31 collaboration that there is a strong correlation between CV outcomes and degree of BP reduction. However, inconsistencies do exist and, given the multifactorial etiology of different CV events and the differential impact of various antihypertensive agents on established CV risk factors (other than BP) and on duration of BP-lowering action, it seems unlikely that all antihypertensives would exert the same CV benefits for the same degree of clinic BP reduction.