From the Guidelines
Patients Requiring Cardiology Follow-up
Patients with hypertension who have stage 2 hypertension with BP ≥160/100 mm Hg should be referred to cardiology for follow-up, as they require prompt treatment and careful monitoring 1.
- Those with diabetes mellitus or chronic kidney disease are automatically placed in the high-risk category and should be referred to cardiology for follow-up 1.
- Patients with evidence of atherosclerotic cardiovascular disease (ASCVD) risk should also be referred to cardiology, as intensive BP-lowering therapies should be directed toward patients with the highest ASCVD risk 1.
- Additionally, patients who require initiation of pharmacologic therapy with 2 antihypertensive agents from different classes should be referred to cardiology for follow-up and monitoring 1.
- It is also recommended to refer patients who are at high risk of cardiovascular disease, such as those with a history of coronary artery disease, stroke, or peripheral artery disease, to cardiology for follow-up 1.
From the FDA Drug Label
PRECAUTIONS General Myocardial stimulation produced by hydrALAZINE can cause anginal attacks and ECG changes of myocardial ischemia. The drug has been implicated in the production of myocardial infarction. It must, therefore, be used with caution in patients with suspected coronary artery disease
The patient with suspected coronary artery disease requires cardiology follow-up 2.
From the Research
Patient Selection for Cardiology Follow-up
The decision to refer a patient with hypertension for cardiology follow-up depends on several factors, including the presence of comorbidities, target-organ damage, and the patient's response to treatment.
- Patients with hypertension who have a history of coronary artery disease, heart failure, or chronic kidney disease may require cardiology follow-up, as these conditions often require specialized management and monitoring 3, 4.
- Patients with hypertension who have experienced a myocardial infarction or stroke may also benefit from cardiology follow-up, as they may require more aggressive blood pressure management and monitoring for cardiovascular risk factors 3.
- The presence of target-organ damage, such as left ventricular hypertrophy or proteinuria, may also indicate the need for cardiology follow-up, as these conditions can increase the risk of cardiovascular events 5, 6.
- Patients with resistant hypertension or those who are not responding to treatment may also require cardiology follow-up, as they may require more intensive monitoring and management of their blood pressure 7.
Blood Pressure Targets
The blood pressure targets for patients with hypertension who require cardiology follow-up may vary depending on the individual patient's circumstances.
- For patients with coronary artery disease, a blood pressure target of <140/90 mm Hg is recommended, although a target of <130/80 mm Hg may be appropriate for some patients 3.
- For patients with heart failure, a blood pressure target of 130/80 mm Hg is recommended, although the optimal target may vary depending on the individual patient's circumstances 4.
- For patients with chronic kidney disease, a blood pressure target of <140/90 mm Hg is recommended, although a target of <130/80 mm Hg may be appropriate for some patients 5.
Management of Hypertension
The management of hypertension in patients who require cardiology follow-up typically involves a combination of lifestyle modifications and pharmacological therapy.
- Lifestyle modifications, such as dietary changes and increased physical activity, can help to lower blood pressure and reduce cardiovascular risk 5, 7.
- Pharmacological therapy, such as beta-blockers, angiotensin-converting enzyme inhibitors, and calcium channel blockers, can help to lower blood pressure and reduce cardiovascular risk 5, 3, 4.
- The choice of pharmacological therapy will depend on the individual patient's circumstances, including the presence of comorbidities and the patient's response to treatment 5, 3, 4.