Quality Care - everyone, everytime
 

2.5 Hypertension and heart failure

 

  NICE CG127  Clinical Management of primary hypertension in adults  Aug 11 
  NICE CG107 Hypertension in Pregnancy Jan 11
  NICE CG108 Chronic Heart Failure in adults Aug 10
  NICE CG95 Chest Pain of Recent Onset March 10
  NICE Hypertension treatment pathway  
  NICE Chronic heart failure treatment pathway  

2.5.1 Vasodilator antihypertensive drugs

      HYDRALAZINE(Yellow)  
        SODIUM NITROPRUSSIDE  

2.5.2 Centrally acting antihypertensive drugs

      CLONIDINE  
      METHYLDOPA (Yellow) (Green in Pregnancy)  
      MOXONIDINE (Yellow)  

2.5.4 Alpha-adrenoceptor blocking drugs

      DOXAZOSIN Conventional release preferred due to cost issues
          Conventional release provides 24 hour cover. BNF approved up to 16mg in 24 hours
          Doxazosin may be useful in patients with co-existing BPH

2.5.5.1 Angiotensin-converting enzyme inhibitors

1st     RAMIPRIL     
1st     LISINOPRIL    
1st     ENALAPRIL    
1st(Stroke/Elderly)     PERINDOPRIL    
             
  ACE Inhibitors are the first choice for hypertension in diabetics. Monitor blood pressure and electrolytes 7-14 days after starting treatment or changing doses, then at least annually. Monitor EGFR in kidney disease patients at every dose increase.
   
        MHRA Drug Safety Update ACE Inhibitors not to be used in pregnancy Dec 07
        MHRA Drug Safety Update ACE Inhibitors not to be used in breast feeding mothers in first few weeks after delivery May 09
             

2.5.5.2 Angiotensin-II receptor antagonists

     NICE TA388 - SACUBITRIL VALSARTAN (Yellow)
1st in heart failure      CANDESARTAN     
1st in hypertension     LOSARTAN    
      IRBESARTAN Use only in patients who have to discontinue ACE inhibitors due to troublesome cough 
          Monitor blood pressure and electrolytes 7-14 days after starting treatment or changing doses, then at least annually

 

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