CHAPTER 1 Cardiovascular System^37
- Smoking
- Dyslipidemia—elevated cholesterol, LDL, triglycerides, low HDL
- Diabetes
- Age greater than 60
- Men and postmenopausal females
- Family history
Non-pharmacologic interventions are tried first, then medications are pre-
scribed.
There is a four-step treatment plan:
- Step 1:
- Lifestyle changes
- Reduce caloric intake and exercise to reduce weight
- Low-sodium diet
- No smoking
- Reduce alcohol intake
- Reduce caffeine intake
- Step 2: Begin medication
- Administer diuretics to reduce circulating blood volume:
- furosemide, spironolactone, hydrochlorothazide, bumetanide
- Beta-adrenergic blockers to lower heart rate and cardiac output:
- propranolol, metroprolol, atenolol
- Calcium channel blockers to cause peripheral vasodilation, less tachycardia:
- verapamil, diltiazem, nicardipine
- Administer ACE to inhibit the rennin angiotensin aldosterone system. In
diabetes, ACE inhibitors also delay the progression of renal disease.- enalapril, lisinopril, benazepril, captopril, fosinopril, quinapril, perin-
dopril
- enalapril, lisinopril, benazepril, captopril, fosinopril, quinapril, perin-
- Administer diuretics to reduce circulating blood volume:
- Step 3:
- Increase dosages of currently administered medication
- Step 4:
- Combination of agents in above classes
- Multiple drugs may be needed to control blood pressure