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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Tuesday, October 14, 2008
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Tuesday, October 14, 2008
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High Blood Pressure |
Congestive Heart failure and treatment05/18/2000 01:28PM |
Briefly,What is the best treatment for Congestive heart failure (caused by High blood pressure)
There are two types of heart failure: In the first form, the left ventricle of the heart has been weakened and is no longer strong enough to pump enough blood, especially during exercise. The patient gets fatigued and short of breath with minor activity. This form is called systolic dysfunction. It is often caused by coronary artery disease, but high blood pressure is also a major risk factor. The second form of heart failure is caused by abnormal thickening of the heart muscle. This is called diastolic dysfunction and is almost always due to high blood pressure. In that situation, the left ventricle of the heart cannot receive enough blood during the filling phase, because the heart muscle is stiff and cannot relax quickly enough. The two forms of heart failure can be distinguished by a test called cardiac ultrasound. Although the symptoms are similar in both types of heart failure, the treatment is different. Therefore, an ultrasound should be done in each patient with congestive heart failure prior to starting treatment.The current recommendations for treatment of hypertensive heart disease (diastolic dysfunction) include: 1) Treatment or elimination of the major risk factors, which include high blood pressure, diabetes, high cholesterol and cigarette smoking. 2) Reduction of work load. The patient should reduce physical and psychological stress and excess activity. This can be followed by a careful exercise program as tolerated. 3) Reduction in salt intake. Diet should also include reduction in calories if the patient is overweight. 4) Diuretics (water pills) should be used as needed to reduce excess salt and fluid in the body. They have to be used carefully to avoid too much volume loss. 5) High blood pressure should be treated aggressively. It is important to use drugs that do not cause an increase in heart rate. A slow heart rate (pulse of around 60) gives the heart more time to fill with blood during the filling phase and improves cardiac performance. Beta blockers and calcium blockers such as verapamil or diltiazem can be very useful. 6) Angiotensin Converting Enzyme (ACE) inhibitors are blood pressure drugs that have been shown to be able to reduce the size of an enlarged heart muscle. They should be given to all patients with heart failure. ACE inhibitors include captopril, lisinopril and quinapril. If ACE inhibitors are not tolerated, Angiotensin Receptor Blockers (such as losartan, irbesartan or candesartan) can be used instead.
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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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