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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Friday, March 19, 2010
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Friday, March 19, 2010
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Heart Failure |
Medication Dosage and Options01/07/2009 |
1. I am hypertensive and 2D echo was done. LVEF is 0.65% : Concentric Left Vntricular Hypertrophy : Normal LV function ( both Syst and Dyst ) No I/C Clot or RWMA at Rest. Kindly review and evaluate my cardiac 2D echo. 2. I am on Atenolol:100 mg since 1989 and recently My doctor put me to Nebivolol 5 mg once. My question is 1.Is Nebivolol superior to Atenolol because the later has nitric oxide release properties and better cardioprotective ? 2. Is dose equivalence of Atenolol 100 and Nebivolol-5mg same ? 3. Is Perindopril 4 mg equal to losartan 50 mg ? 4. Does diruitic like HCTZ or Indapamide harmful in petting oedema. 5. Ace Inhibitor or ARB which is better from cardiac point of view ?
1. Left ventricular hypertrophy (LVH) is a consequence of long standing hypertension. Its presence is an independent risk factor for cardiovascular disease. Even with normal left ventricular function, LVH is a major risk factor and requires aggressive treatment of hypertension, probably to a goal of 130/80. This lower goal has not been definitely proven to be superior to the older goal of 140/90, but there is a lot of circumstantial evidence to advise it.
2. The dosing of antihypertensive medication varies from patient to patient, and is best decided upon according to the individual blood pressure results. Nebivolol may be superior to atenolol because of its longer half-life and better 24 hour efficacy. There are no data to show any cardio-protective effects of atenolol or nebivolol in addition to their antihypertensive efficacy (the exception being in patients who suffered a myocardial infarction).
However, a large, well-designed trial in patients with left ventricular hypertrophy has shown that losartan is superior to atenolol in reducing cardiovascular events, especially stroke. (This effect was not seen in black patients.)
3. Perindopril 4 mg can be considered as roughly equivalent to 50 mg losartan, but again, individual responses vary.
4. Diuretics are most helpful in improving blood pressure control, especially when added to ACE inhibitors, angiotensin receptor blockers or beta blockers. They should be part of most antihypertensive regimens. They do not cause edema and often reduce it.
5. Both ACE inhibitors and angiotensin receptor blockers have been shown to reduce morbidity and mortality in patients with heart disease, especially post-myocardial infarction and in cases of heart failure. These effects are seen in addition to blood pressure lowering and appear to be due to angiotensin inhibition per se.
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Max C. Reif, MD Director, Hypertension Section Division of Nephrology & Hypertension Department of Internal Medicine College of Medicine University of Cincinnati |
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