Lipid Lowering Therapy Algorithm for Hypertension

Toolkit for Implementing the Chronic Care Model in an Academic Environment

The Planned Visit Notebook includes a step-by-step description for a diabetes planned visit. The Lipid Lowering Therapy Algorithm for Hypertension is a flowchart that takes a health professional through the steps for one part of the diabetes planned visit.

Lipid Lowering Therapy Algorithm for Hypertension. For details, go to [D] Text Description.
The Lipid Lowering Therapy Algorithm begins with a text box that reads:

Assess Lipid Panel

Goals:
LDL <100 if no CAD
LDL <70 uf PVD or CAD
Triglycerides (TG) <150

Three arrows lead from it. The one to the left is labeled "Lipids at goal and no meds" and points to a box that reads:
Recheck in 1 year
The arrow in the center is labeled "Lipids at goal and on meds" and points to a box that reads:
Recheck in 3-6 months
The arrow to the right is labeled "Lipids not at goal and on meds" and points to a box that reads:

Get a current lipid panel if last panel >6 months if there have been no recent pharmacy changes.

Get a current lipid panel if last panel >6 weeks with recent pharmacy changes.

Assess lipid lowering medicines, review previous allergy or intolerance to lipid lowering medicines and advise on lifestyle changes.

Determine Primary Target:

Two arrows lead from this box to two boxes below it. The box to the left reads:

If TG <400 and LDL is not at goal
—LDL is the target

1st option—statin at 25 to 50 % of maximal dose
Reassess LFTs, lipids at 6 wks and reclassify patient

2nd option—statin to maximal dose and reassess LFTs, lipids at 6 wks and reclassify patient

3rd LDL option—choice binding agent/Zetia or nicotinic acid and reassess LFTs, lipids at 6 wks and reclassify patient.

____________________________________________________

When patient is at goal recheck in 3-6 months

The box to the right reads:

If TG 151-400 but LDL is at goal—TG is the target
Or /
If TG >400—Then TG is the target

1st option—Lopid 600 twice daily Or/
Tricor 54-145 daily depending on degree of TG elevation
Reassess and Reclassify according to levels at 6 weeks (lipids, liver profile)

Still in TG Group ?

2nd TG option—Statin 25 to 50 % of maximal dose
Reassess LFTs, lipids and reclassify patient

3rd TG option—increase statin to maximal dose
Reassess and reclassify according to levels at 6 weeks (lipids, liver profile)

4th TG option—omega 3 FA or nicotinic acid and work up to maximal dose
Reassess and Reclassify according to levels at 6 weeks (lipids, liver profile)

5th TG option—omega 3 FA or nicotinic acid (depending on what was added) and work up to maximal dose

____________________________________________________

When patient is at goal recheck in 3-6 months

A note at the bottom of the algorithm reads:

Note:

  • Whenever a patient is put on a new lipid lowering medicine and adjust medication they should be contacted in 1 week to assess tolerance and adherence. Consultation with endocrinologist is an option at any point along the pathway.
  • Whenever medication is changed or added, recheck lipid panel and liver profile in 6 weeks.

Return to Document

Current as of January 2008
Internet Citation: Lipid Lowering Therapy Algorithm for Hypertension: Toolkit for Implementing the Chronic Care Model in an Academic Environment. January 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/chroniccaremodel/chronic2a9.html