MIMS class : ACE Inhibitors
Dosage
Adult: PO HTN As erbumine: Initial: 4 mg once daily. Patients w/ renovascular HTN, vol depletion, severe HTN: Initial: 2 mg once daily. Max: 8 mg/day. Patients on diuretics: Withdraw diuretics 2 or 3 days before perindropil therapy. Resume later if required. If diuretic cannot be discontinued, an initial dose of 2 mg once daily. Max: 8 mg/day. Heart failure As erbumine: Initial: 2 mg in the morning. Increase slowly if needed. Maintenance: 4 mg/day. Stable ischaemic heart As erbumine: Initial: 4 mg once daily for 2 wk. Maintenance: 8 or 10 mg once daily.
Administration:
Should be taken on an empty stomach. (Take before meals.)
Conraindication:
History of angioedema related to previous ACE inhibitor treatment. Pregnancy (2nd/3rd trimesters).
Special Precaution:
History of airway surgery. Withdraw if there is significant increase in LFTs. Risk factors for hyperkalaemia; monitor potassium closely. Patients dependent on renin-angiotensin-aldosterone system; consider withdrawal in patients with progressive deterioration in renal function. Collagen vascular disease. Hypovolaemia; monitor BP with the 1st dose. Unilateral renal artery stenosis and pre-existing renal insufficiency; valvular aortic stenosis. Before, during, or immediately after anaesthesia. May impair ability to drive or operate machinery. Lactation.
Adverse Reaction
Headache, dizziness, sleep disorders, depression, fever, nervousness, somnolence; cough, upper respiratory tract infection, sinusitis, rhinitis, pharyngitis; oedema, chest pain, abnormal ECG, palpitation; rash; hyperkalaemia, elevated triglycerides, menstrual disorder; nausea, diarrhoea, vomiting, dyspepsia, abdominal pain, flatulence: UTI, sexual dysfunction; increased LFTs; weakness, musculoskeletal pain, upper and lower extremity pain, hypertonia, paraesthesia; proteinuria; tinnitus, ear infection; viral infection, allergy.
Potentially Fatal: Anaphylactoid reactions, angioedema.
Pregnancy Category
Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).
Source:
http://www.mims.com/Malaysia/drug/info/perindopril/?q=perindopril
Monday, May 23, 2011
Tuesday, May 17, 2011
Management Of Hypertension: CPG 2008 : PHARMACOLOGY
 |
| ALGORITHM OF HYPERTENSION |
http://www.infosihat.gov.my/media/garisPanduan/CPG/CPG%20Hypertension/CPG%20Hypertension.pdf
PREHYPERTENSION
Management of prehypertension
• All patients should be managed with non-pharmacologic interventions/therapeutic lifestyle modifications to
lower BP. (see Chapter 5)
• There should be yearly follow-up in patients with prehypertension to detect and treat hypertension as early
as possible. (Level III)
• Decisions regarding pharmacological treatment should be based on the individual patient’s global CVD risk.
In diabetes mellitus or chronic kidney disease, medical treatment is
required if BP is above 130/80 mmHg. 25-27 (Level I) Similarly, in other high risk subjects such as those
with previous CVA or CAD, the threshold for commencing hypertension treatment should be lower in
patients with prehypertension. 28-31 (Level I)
Sunday, May 8, 2011
DEFINITION AND CLASSIFICATION OF HYPERTENSION : CPG 2008
DEFINITION AND CLASSIFICATION OF HYPERTENSION
Hypertension is defined as persistent elevation of systolic BP of
140 mmHg or greater and/or diastolic BP of 90 mmHg or greater.
There is a positive relationship between systolic blood pressure (SBP), diastolic blood pressure (DBP) and the risk of developing cardiovascular, cerebrovascular and renal diseases. Therefore the main aim of identifying and treating high BP is to reduce these risks.
Hence BP should be measured at every clinic encounter.
The classification of high BP, although arbitrary, is useful as clinicians
must make treatment decisions based on the measured BP and the
patients’ associated cardiovascular/cerebrovascular risks and comorbidities.
Table 1 provides a classification of BP for adults (age 18 and older). The WHO-ISH guidelines in principle have adopted a similar classification.1
These criteria are for subjects who are not on any antihypertensive medication and who are not acutely ill.
Table 1. Classification of blood pressure for adults age 18 and older
Category Systolic Diastolic Prevalence in (mmHg) (mmHg) Malaysia
Doctors should explain to patients the significance of their BP
readings. The need for follow-up and treatment if necessary should
be emphasized. Table 6 on page 9 provides follow-up
recommendations based on the initial set of BP measurements.
Hypertension is defined as persistent elevation of systolic BP of
140 mmHg or greater and/or diastolic BP of 90 mmHg or greater.
There is a positive relationship between systolic blood pressure (SBP), diastolic blood pressure (DBP) and the risk of developing cardiovascular, cerebrovascular and renal diseases. Therefore the main aim of identifying and treating high BP is to reduce these risks.
Hence BP should be measured at every clinic encounter.
The classification of high BP, although arbitrary, is useful as clinicians
must make treatment decisions based on the measured BP and the
patients’ associated cardiovascular/cerebrovascular risks and comorbidities.
Table 1 provides a classification of BP for adults (age 18 and older). The WHO-ISH guidelines in principle have adopted a similar classification.1
These criteria are for subjects who are not on any antihypertensive medication and who are not acutely ill.
Table 1. Classification of blood pressure for adults age 18 and older
Category Systolic Diastolic Prevalence in (mmHg) (mmHg) Malaysia
Doctors should explain to patients the significance of their BP
readings. The need for follow-up and treatment if necessary should
be emphasized. Table 6 on page 9 provides follow-up
recommendations based on the initial set of BP measurements.
Key Messages : Clinical Practise Guideline on Hypertension, 2008
KEY MESSAGES: CLINICAL PRACTICE GUIDELINE
ON HYPERTENSION, 2008
1. Hypertension is defined as persistent elevation of systolic BP of 140
mmHg or greater and/or diastolic BP of 90 mmHg or greater.
2. The prevalence of hypertension in Malaysians aged 30 years and
above was 42.6% in 2006.
3. Hypertension is a silent disease; the majority of cases (64%) in the
country remain undiagnosed. Blood pressure should be measured
at every chance encounter.
4. Untreated or sub-optimally controlled hypertension leads to
increased cardiovascular, cerebrovascular and renal morbidity and
mortality.
5. A systolic BP of 120 to 139 and/or diastolic BP of 80 to 89 mmHg
is defined as prehypertension and should be treated in certain high
risk groups.
6. Therapeutic lifestyle changes should be recommended for all
individuals with hypertension and prehypertension.
7. Decisions on pharmacological treatment should be based on global
vascular risks and not on the level of blood pressure per se.
8. In patients with newly diagnosed uncomplicated hypertension and
no compelling indications, choice of first line monotherapy includes
ACEIs, ARBs, CCBs and diuretics. Beta blockers are no longer
recommended for first line monotherapy in this group of patients.
9. Only 26% of Malaysian patients achieved blood pressure control
(<140/90 mmHg) while on treatment. Every effort should be made
to achieve target blood pressure. Target blood pressure depends
on specific patient groups.
10. Combination therapy is often required to achieve target and may
be instituted early.
ON HYPERTENSION, 2008
1. Hypertension is defined as persistent elevation of systolic BP of 140
mmHg or greater and/or diastolic BP of 90 mmHg or greater.
2. The prevalence of hypertension in Malaysians aged 30 years and
above was 42.6% in 2006.
3. Hypertension is a silent disease; the majority of cases (64%) in the
country remain undiagnosed. Blood pressure should be measured
at every chance encounter.
4. Untreated or sub-optimally controlled hypertension leads to
increased cardiovascular, cerebrovascular and renal morbidity and
mortality.
5. A systolic BP of 120 to 139 and/or diastolic BP of 80 to 89 mmHg
is defined as prehypertension and should be treated in certain high
risk groups.
6. Therapeutic lifestyle changes should be recommended for all
individuals with hypertension and prehypertension.
7. Decisions on pharmacological treatment should be based on global
vascular risks and not on the level of blood pressure per se.
8. In patients with newly diagnosed uncomplicated hypertension and
no compelling indications, choice of first line monotherapy includes
ACEIs, ARBs, CCBs and diuretics. Beta blockers are no longer
recommended for first line monotherapy in this group of patients.
9. Only 26% of Malaysian patients achieved blood pressure control
(<140/90 mmHg) while on treatment. Every effort should be made
to achieve target blood pressure. Target blood pressure depends
on specific patient groups.
10. Combination therapy is often required to achieve target and may
be instituted early.
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