Week 4 CT Cardiovascular

What is the prevalence of hypertension in Australian adults?

Approximately 1 in 3 adults have hypertension or are on BP medication

Which populations have higher risk of hypertension?

Older adults and Indigenous Australians

What medications can cause high blood pressure?

Ibuprofen, indomethacin, naproxen sodium

What is hypertension?

A condition where the force of blood against artery walls is consistently high

What factors contribute to hypertension pathophysiology?

Arterial constriction, increased blood volume, overactive sympathetic nervous system, RAAS activation, endothelial dysfunction

How is blood pressure classified in adults?

Normal <120/80, Elevated 120-129/<80, Stage 1 130-139/80-89, Stage 2 ≥140/90

When should antihypertensive therapy be initiated?

In patients with hypertension and risk of CVD event in next 5 years

Name the main classes of antihypertensive drugs.

ACE inhibitors/ARBs, calcium channel blockers, thiazide diuretics, beta blockers

How do ACE inhibitors/ARBs work?

Block RAAS, reduce angiotensin II, causing vasodilation and reduced sodium/water retention

Give examples of ACE inhibitors/ARBs.

Perindopril, ramipril, irbesartan, candesartan, telmisartan

How do dihydropyridine calcium channel blockers work?

Reduce calcium entry into vascular smooth muscle, causing vasodilation

Give examples of dihydropyridine calcium channel blockers.

Amlodipine, felodipine, lercanidipine

How do thiazide diuretics lower blood pressure?

Inhibit sodium and chloride reabsorption, increase mild diuresis, reduce peripheral vascular resistance

Give examples of thiazide diuretics.

Hydrochlorothiazide, chlorthalidone, indapamide

When are beta blockers used for hypertension?

Not first-line; used for heart failure, post-MI, angina, arrhythmias

Give examples of beta blockers.

Metoprolol, bisoprolol, atenolol, carvedilol

What is dyslipidemia?

Abnormal levels of blood lipids

Why is cholesterol-lowering therapy important?

Reduces LDL-C and prevents/reduces atherosclerotic CVD

What are target lipid levels?

TC

What is LDL-C’s role in atherosclerosis?

Primary causal factor; accumulates in artery walls causing plaque

What are major classes of lipid-lowering drugs?

Statins, ezetimibe, PCSK9 inhibitors, fibrates

How do statins work?

Inhibit hepatic cholesterol synthesis, reduce LDL-C

Why are statins first-line therapy?

Profound LDL-C reduction, mortality benefit, safe, cost-effective

How does ezetimibe work?

Inhibits intestinal cholesterol absorption via NPC1L1 transporter

How do PCSK9 inhibitors work?

Enhance LDL receptor activity to increase LDL clearance

How do fibrates work?

Activate PPAR-α to lower triglycerides

Why might combination lipid therapy be needed?

To achieve very low LDL-C targets not reached with single therapy

What is heart failure (HF)?

A progressive syndrome where the heart cannot fill or eject blood properly

How many Australians are affected by HF?

~480,000

What are common causes of HF?

Coronary heart disease and hypertension

What is prognosis of HF?

50% of diagnosed patients survive 5 years

What is HFrEF?

Heart failure with reduced ejection fraction (<40%), left ventricle cannot contract properly

What is HFpEF?

Heart failure with preserved ejection fraction, ventricle cannot relax and fill

What are common HF symptoms?

Dyspnoea, orthopnoea, fatigue, paroxysmal nocturnal dyspnoea

How is HF classified by NYHA?

Class I–IV based on activity limitation

Describe NYHA Class I

No limitation of ordinary physical activity

Describe NYHA Class II

Slight limitation, no symptoms at rest

Describe NYHA Class III

Marked limitation, no symptoms at rest

Describe NYHA Class IV

Symptoms at rest or with any activity

What non-drug treatments help HF?

Salt and fluid restriction, weight reduction, smoking cessation, limit alcohol, psychosocial support, exercise

What pharmacological treatments are used in HFrEF?

ACE-Is/ARBs, beta-blockers, mineralocorticoid receptor antagonists, ARNI, SGLT2 inhibitors

What is HFmrEF?

Heart failure with mildly reduced ejection fraction (LVEF 41–49%)

Are HFrEF drugs used in HFmrEF?

Yes, similar therapies including SGLT2 inhibitors

What is the benefit of SGLT2 inhibitors in HFmrEF?

Reduce risk of cardiovascular death and HF hospitalisation