Titration of Renin-Angiotensin System Inhibitors in Patients with Heart Failure with Reduced Ejection Fraction and an “At-Goal” Blood Pressure

Initiation and titration of guideline-directed medical therapy is paramount for patients with heart failure with reduced ejection fraction (HFrEF), as it reduces the risk of death and other complications. Despite this, many patients do not receive the appropriate therapies or doses due to concerns and/or misconceptions about the use of these therapies. One reason often cited for not using or titrating inhibitors of the renin-angiotensin system is that blood pressure is already “at goal” or is “too low”. In this blog, the data surrounding titration of angiotensin converting enzyme inhibitors, angiotensin II receptor blockers and the angiotensin II receptor blocker/neprilysin inhibitor in patients with HFrEF will be addressed.

New Year, New Goals: Review of the 2017 ACC/AHA Hypertension Guidelines

It’s about time to start thinking about New Year’s resolutions, so why not add 130/80 mmHg to your list of goals for 2018? A major overhaul of the blood pressure guidelines were recently published, and they include stricter blood pressure goals, restaging of hypertension, and stronger recommendations for out-of-office blood pressure monitoring. Read on for details!

No Love Lost for Intravenous Labetalol Infusions: Risks of Prolonged Use

Labetalol is a beta blocker with potent antihypertensive effects, and it may be administered orally or intravenously. The latter feature makes it especially useful for the acute management of elevated blood pressure but prolonged infusions can result in hemodynamic collapse. In this entry, two cases are discussed and recommendations are made for the appropriate management of continuous labetalol infusions.

Mineralocorticoid Receptor Antagonists: The Cardiovascular Wonder Class (Part 2)

In Part 1 of this two-part series, we dissected the evidence behind the use of MRAs in HFrEF, HFpEF and MI to further understand the reasons for their underutilization and alleviate some of those concerns. In Part 2, the use of MRAs in resistant hypertension will be discussed, as well as considerations regarding blood pressure, potassium, and renal effects given these may play key roles in precluding MRA use when warranted.

Which Thiazide-Type Diuretic Should be First-Line in Patients with Hypertension?

The Eighth National Joint Committee recommends a thiazide-type diuretic as one of the first line treatment options for patients with hypertension. However, there is substantial evidence to support the use of a thiazide-like diuretic (e.g., chlorthalidone) over a thiazide diuretic (e.g., hydrochlorothiazide or HCTZ). In this piece, we review the data on why thiazide-like agents should be preferred in this setting.