Update in Outpatient Medicine JNC 8, Hypertension and More
|
|
- Adam Craig
- 6 years ago
- Views:
Transcription
1 Update in Outpatient Medicine JNC 8, Hypertension and More March 6 th 2015 Robert Gluckman, MD, FACP CMO Providence Health Plans Disclosures Stock Holdings Abbott Labs Abbvie Bristol Myers Squibb GE Proctor and Gamble Walgreens Topics Hypertension New Guidelines Applying treatment targets to individuals Protocols to get to target Cancer screening in the elderly Colon Cancer Screening Benefit and Cost of Supplemental U/S for breast cancer screening women with dense breasts Cost Effectiveness of Lung Cancer Screening New Lipid Guidelines New Agent for CHF 2014 Evidence-Based Guideline for the Management of Hypertension: JNC 8 Evidence based review focused on 3 questions; 9 recommendations Does initiating pharmacologic therapy at specific BP thresholds improve health outcomes? Does pharmacologic treatment targeted to a specific BP goal improve health outcomes? Do various anti-hypertensive drugs/classes differ in comparative benefits/harms for specific health outcomes? JAMA 2014; 311:
2 2014 Evidence-Based Guideline for the Management of Hypertension: JNC 8 Recommended BP targets and treatment regimens based on age, race, presence of DM/CKD. General population age 60 treat to target SBP 150, DBP 90 (Grade A) Patients currently tolerating treatment with BP 140/90 do not require adjustment (Grade E) General population age < 60 initiate treatment to target DBP <90 (Grade A Grade E 18-29) 2014 Evidence-Based Guideline for the Management of Hypertension: JNC 8 General population age < 60 initiate treatment to SBP < 140 (Grade E) In patients age 18 with DM or CKD initiate treatment to target BP <140/90 (Grade E) In general population non-black patients, including patients with DM, initiate treatment with thiazide or CCB or ACE or ARB (Grade B) 2014 Evidence-Based Guideline for the Management of Hypertension: JNC 8 In patients with CKD, regardless of race or DM, initiate or add ACE or ARB to treatment (Grade B) In black patients including with DM, initiate treatment with thiazide or CCB (Grade B, DM recommendation Grade C) In patients not controlled after 1 month of treatment, increase dose or add 2 nd medication. Patients uncontrolled on 3 agents consider BP med not specified in guideline or refer Impact of BP Control on Mortality Risk and ESRD Retrospective cohort study of 396,419 treated hypertensives from Kaiser Permanente Southern California Excluded ESRD and CHF Average age 64 Subgroup analyses for DM, age >70 Follow up 4-5 years JACC 2014;64:588-97
3 BP Lowering in Type 2 DM: A Systematic Review and Meta-analysis Forty trials deemed of low risk of bias Stratified results based on patients initial BP Noted reduced CVA and albuminuria (not other outcomes) if achieved BP lower than 130/80 Individualized targets based on age and comorbidity may result in better outcomes JAMA 2015;313: Treatment with Multiple BP Medications, Achieved BP and Mortality in NH Residents- The PARTAGE Study 1127 nursing home residents age > 80 Measured BP over 3 consecutive days 2 year follow-up Assessed medication use Excluded patients without hypertension on meds for other conditions JAMA Int Med published online 2/16/2015
4 Cost Effectiveness of Hypertension Therapy According to 2014 Guidelines Used a computer simulation model to predict incidence, prevalence, and mortality of CHD and CVA among persons age Categorized patients as Stage 1 SBP , DBP Stage 2 or higher SBP 160, DBP 100 Estimated 56,000 cardiac events and 13,000 deaths prevented in the US each year NEJM 2015: Summary- New BP Guidelines and Targets Implications for Performance Measurement BP targets raised for patients 60 and older BP targets raised for patients with DM, CKD ACE/ARB preference removed for hypertensive patients with DM unless CKD or albuminuria Drug choices differ by race, (use thiazide or CCB in black patients unless CKD Performance measures allow looser control Important to remember to individualize approach Younger patients with DM, CKD consider more aggressive target, Relax treatment in old, frail patients Improved BP Control with a Large Scale Hypertension Program 652,763 patients in KPNC registry compared to other California insurers participating in NCQA 5 components to program Development of a registry Sharing of performance metrics Evidence based guidelines MA BP visits Single pill combination therapy (diuretic plus ACE) JAMA 2013;
5 Improved BP Control with a Large Scale Hypertension Program 4 step drug therapy Thiazide or Thiazide plus ACEI Thiazide plus ACEI CCB (i.e. amlodipine) Spironolactone or beta blocker PHP % MA visit 2-4 weeks after med change No co-pay Allowed more rapid treatment intensification JAMA 2013;310: Epidural Steroids for Spinal Stenosis 400 patients age 50 with lumbar central spinal stenosis and moderate to severe leg pain and disability Epidural Steroids for Spinal Stenosis Randomized to receive epidural injections of glucocorticoid plus lidocaine vs. lidocaine alone Received one or two injections before outcome evaluation 6 weeks after first injection Primary Outcome Roland-Morris Disability Questionnaire Rating intensity of leg pain (0-10)
6 Epidural Steroids for Spinal Stenosis Treatment of lumbar spinal stenosis with glucocorticoid plus lidocaine injections offered minimal to no benefit at 6 weeks Although sham injections were not performed, there is no evidence to support injections for the treatment of spinal stenosis. Consider behavioral/pt programs for non-surgical candidates Cancer Screening in Patients with Limited Life Expectancies Retrospective cohort analysis of 27,911 patients aged 65 and older Data derived from the National Health Interview Survey, self reported cancer screening rates Mortality index developed and patients grouped into low (<25%), intermediate (25-49%), high (50-74%, or very high (>75%) mortality in 5 and 9 years. JAMA IM 2014;174(10): Estimating Prognosis for Elders Charlson Co-Morbidity Index Calculator
7 Should CRC Screening be Considered in Previously Unscreened Elderly Persons Microsimulation modeling study using observational and experimental studies One time screening with colonoscopy, sigmoidoscopy, or FIT in previously unscreened persons aged with no, moderate, severe comorbid conditions Cost effectiveness threshold $100,000 per QALY Ann Intern Med 2014;160: Multi-target Stool DNA Testing for CRC Screening 12,776 patients age at average risk for CRC enrolled at 90 sites Excluded patients with previous colonoscopy within 9 years, + fecal blood in past 6 months. Multi-target Stool DNA Testing for CRC Screening 9989 participants could be fully evaluated 1168 did not undergo colonoscopy 723 had insufficient stool or other sample issues 304 had incomplete colonoscopy Specificity for stool DNA lower in patients over 65 Lower cutoffs for positive FIT (20µg/g produces similar sensitivity/specificity to stool DNA
8 Multi-target Stool DNA Testing for CRC Screening Multitargeted Stool DNA testing is significantly more sensitive than FIT for colorectal cancer detection FIT is more specific for colorectal cancer detection than multitargeted stool DNA testing Lowering threshold of a positive FIT may result in equivalent performance Baseline risk is an important consideration in determining the best test for patients Multitargeted DNA may be appropriate in previously unscreened patients who refuse colonoscopy or have comorbidities FIT may be more appropriate for older patients with previous negative colonoscopy where colonoscopy may pose higher risks and lower benefit Long Term CRC Mortality After Adenoma Removal Cohort study Cancer Registry and Cause of Death Registry of Norway 40,826 patients followed median 7.7 years after adenoma removal Norwegian standard of care 10 year surveillance for high risk adenoma 5 year surveillance for 3 or more adenomas No surveillance for low risk adenomas or for patients > 74 years old CRC mortality primary endpoint Reviewed 442 pathology reports and reclassified 8.2% of cases from high to low risk and 30.2% from low risk to high risk Thus the risk may have been overstated in both cohorts if patients were correctly classified.
9 Long Term CRC Mortality After Adenoma Removal Patients with 1-2 low risk adenomas have a lower risk of CRC death than average population Current guidelines recommend surveillance 5-10 years after resection of low risk adenomas Difficult to justify surveillance sooner than 10 years in low risk adenoma patients Surveillance Colonoscopy in Elderly Patients Retrospective cohort study 27,763 patients age 50 undergoing surveillance colonoscopy from through 2010 at Southern California Kaiser 4834 patients age 75 Primary outcome- incidence of CRC Secondary outcome- 30 day post procedure hospitalization Procedure related (i.e. GI bleed, perforation, arrhythmia) Other GI disorder Other JAMA IM 2014;174(10): Low incidence of CRC in elderly possibly explained by previous removal of potentially malignant lesions or death from other comorbid conditions
10 PHP Colonoscopy Indications in the Elderly Surveillance colonoscopy in the elderly Surveillance colonoscopy in older patients appears to be low yield Healthy patients with previous high risk findings likely benefit most Risks of colonoscopy increase with age and co-morbidity Assessing co-morbidities may help guide decisions for individual patients Surveillance strategies in the elderly should consider opportunity for cancer prevention vs mortality reduction Stool based surveillance may be a reasonable alternative for selected patients, especially over age 75. (My opinion: Current guidelines for surveillance in the elderly are based on opinion) Benefits, Harms, and Cost Effectiveness of Supplemental U/S for Women with Dense Breasts 19 states, including Oregon, require providers to notify patients about their breast density Evidence is limited but suggests increased cancer detection at the expense of increased biopsies Used 3 established models to develop estimates of benefits, harms and cost effectiveness of supplemental U/S in women with dense breasts Annals of IM published online Dec 9, 2014
11 Supplemental Screening Strategy Biennial Screening Age QALY s Gained Cost per QALY Supplemental ultrasound for BI-RADS 4 Supplemental ultrasound for BI-RADS 3-4 Annual Screening age per 1000 women 1.7 per 1000 women $246,000 $325,000 Supplemental ultrasound for BI-RADS per 1000 women $553,000 Supplemental ultrasound for BI-RADS per 1000 women $728,000 Cost Effectiveness of CT Screening in the NLST NLST enrolled patients age with 30 pack-yr smoking history Current smokers or quit within 15 years USPTF Grade B recommendation age Medicare coverage limited to patients age Screening consisted of 3 annual low dose CT scans Benefits are much greater in high risk patients NNS 161 vs in highest vs. lowest risk patients NEJM 2014;371: ; NEJM 2013;369:245-54
12 Lung Cancer Risk Calculator Medicare requires shared decision making for coverage of lung cancer screening. Further Insight into the Cardiovascular Risk Calculator: Data from the Women s Health Study 27,542 women free from CV disease with complete ascertainment of lipids and other risks Followed median 10 years with annual questionnaires Analyses adjusted for statin use and revascularization Statin use increased to 37.5% of higher risk women at 10 years 1.4% underwent revascularization;5.2% in highest risk patients JAMA IM 2014;174 (12) Statin Usage In PHP Patients With ASCVD and DM
13 New Lipid Guidelines Controversy over lipid calculator for primary prevention Emphasis on statin prescribing at appropriate dose for patients with known CVD or DM Patient adherence is much lower than can be explained by side effects Strategies to assess and promote adherence essential Statin use in risk populations new proposed performance measure Angotensin-Neprilysin Inhibition vs. Enalapril in Heart Failure 8442 patients with CHF, EF < 40%, NYHA Class II- IV, elevated BNP randomized to LCZ696 vs enalapril 70% NYHA Class II, 30% Class III Protocol changed to EF 35% mid trial Excluded patients with BP <100, CrCl < ml/min Primary Outcome- Death from CV causes or 1 st hospitalization for worsening CHF Trial terminated at 27 months due to overwhelming benefit NEJM 2014;371: Angotensin-Neprilysin Inhibition vs. Enalapril in Heart Failure LCZ696 Enalapril NNT Total Mortality 17% 19.8% 36 CV mortality or 21.8% 26.5% 21 1 st CHF Hosp 1 st CHF Hosp 12.8% 15.6% 36 Angotensin-Neprilysin Inhibition vs. Enalapril in Heart Failure Combined angiotensin/neprilysin inhibition was superior to angiotensin inhibition in reducing death, CHF hospitalization and symptoms without significant differences in adverse events. LCZ696 patients had improved symptoms on KCCQ
14 Questions
Update in Outpatient Medicine ACP Scientific Session November 12, 2016
Update in Outpatient Medicine ACP Scientific Session November 12, 2016 Robert Gluckman MD, MACP Chief Medical Officer Providence Health Plans Disclosures Stock Holdings Abbott Labs Abbvie Bristol Myers
More informationUpdate in Outpatient Medicine. Robert A Gluckman, MD, FACP Chief Medical Officer, Providence Health Plans December
Update in Outpatient Medicine Robert A Gluckman, MD, FACP Chief Medical Officer, Providence Health Plans December 13. 2013 Disclosures Stock holdings Proctor and Gamble Abbvie Abbott Bristol Myers Squibb
More informationMANAGEMENT OF HYPERTENSION: TREATMENT THRESHOLDS AND MEDICATION SELECTION
Management of Hypertension: Treatment Thresholds and Medication Selection Robert B. Baron, MD MS Professor and Associate Dean Declaration of full disclosure: No conflict of interest Presentation Goals
More informationObjectives. Describe results and implications of recent landmark hypertension trials
Hypertension Update Daniel Schwartz, MD Assistant Professor of Medicine Associate Medical Director of Heart Transplantation Temple University School of Medicine Disclosures I currently have no relationships
More informationHypertension in 2015: SPRINT-ing ahead of JNC-8. MAJ Charles Magee, MD MPH FACP Director, WRNMMC Hypertension Clinic
Hypertension in 2015: SPRINT-ing ahead of JNC-8 MAJ Charles Magee, MD MPH FACP Director, WRNMMC Hypertension Clinic Conflits of interest? None Disclaimer The opinions contained herein are not to be considered
More informationUpdate in Hypertension
Update in Hypertension Eliseo J. PérezP rez-stable MD Professor of Medicine DGIM, Department of Medicine UCSF 20 May 2008 Declaration of full disclosure: No conflict of interest (I have never been funded
More informationPreventing and Treating High Blood Pressure
Preventing and Treating High Blood Pressure: Finding the Right Balance of Integrative and Pharmacologic Approaches Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Blood Pressure
More informationNew Lipid Guidelines. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids.
PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Disclosure No relevant
More informationManagement of Lipid Disorders and Hypertension: Implications of the New Guidelines
Management of Lipid Disorders and Hypertension Management of Lipid Disorders and Hypertension: Implications of the New Guidelines Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine
More informationDISCLOSURE PHARMACIST OBJECTIVES 9/30/2014 JNC 8: A REVIEW OF THE LONG-AWAITED/MUCH-ANTICIPATED HYPERTENSION GUIDELINES. I have nothing to disclose.
JNC 8: A REVIEW OF THE LONG-AWAITED/MUCH-ANTICIPATED HYPERTENSION GUIDELINES Tiffany Dickey, PharmD Assistant Professor, UAMS COP Clinical Pharmacy Specialist, Mercy Hospital Northwest AR DISCLOSURE I
More informationADVANCES IN MANAGEMENT OF HYPERTENSION
Advances in Management of Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Current Status of Prevalence 29%; Blacks 33.5%
More informationUpdate in Outpatient Medicine Medical Grand Rounds ACP Scientific Session November 10, 2018
Update in Outpatient Medicine Medical Grand Rounds ACP Scientific Session November 10, 2018 Robert Gluckman MD, MACP Chief Medical Officer Providence Health Plans Disclosures Stock Holdings Abbott Labs
More informationModern Management of Hypertension
Modern Management of Hypertension Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Current Status of Hypertension Prevalence
More informationNew Hypertension Guidelines: Why the change? Neil Brummond, M.D. Avera Medical Group Internal Medicine Sioux Falls, SD
New Hypertension Guidelines: Why the change? Neil Brummond, M.D. Avera Medical Group Internal Medicine Sioux Falls, SD None Disclosures Objectives Understand trend in blood pressure clinical practice guidelines
More informationADVANCES IN MANAGEMENT OF HYPERTENSION
Prevalence 29%; Blacks 33.5% About 72.5% treated; 53.5% uncontrolled (>140/90) Risk for poor control: Latinos, Blacks, age 18-44 and 80,
More informationModern Management of Hypertension: Where Do We Draw the Line?
Modern Management of Hypertension: Where Do We Draw the Line? Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Blood Pressure
More informationTreating Hypertension in 2018: What Makes the Most Sense Today?
Treating Hypertension in 2018: What Makes the Most Sense Today? Daniel Blanchard, MD Professor of Medicine UC San Diego Cardiovascular Center La Jolla, California 1 2 Speaker Disclosures Consultant and/or
More informationManaging Hypertension in 2016
Managing Hypertension in 2016: Where Do We Draw the Line? Disclosure No relevant financial relationships Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine baron@medicine.ucsf.edu
More informationRenal Denervation. by Walead Latif, DO, MBA, CPE Assistant Clinical Professor Rutgers Medical School
Renal Denervation by Walead Latif, DO, MBA, CPE Assistant Clinical Professor Rutgers Medical School Disclosure Information ACOI Annual Meeting I have the following financial relationships to disclose:
More informationHYPERTENSION GUIDELINES WHERE ARE WE IN 2014
HYPERTENSION GUIDELINES WHERE ARE WE IN 2014 Donald J. DiPette MD FACP Special Assistant to the Provost for Health Affairs Distinguished Health Sciences Professor University of South Carolina University
More informationObjectives. Heart failure and Hypertension. Definition & epidemiology of heart failure HEART FAILURE 3/12/2016. Kirsten Bibbins-Domingo, PhD, MD, MAS
Objectives Heart failure and Hypertension Kirsten Bibbins-Domingo, PhD, MD, MAS Lee Goldman, MD Endowed Chair in Medicine Professor of Medicine and of Epidemiology and Biostatistics University of California,
More informationMODERN MANAGEMENT OF HYPERTENSION Where Do We Draw the Line? Disclosure. No relevant financial relationships. Blood Pressure and Risk
MODERN MANAGEMENT OF HYPERTENSION Where Do We Draw the Line? Disclosure No relevant financial relationships Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine baron@medicine.ucsf.edu
More informationAntihypertensive Trial Design ALLHAT
1 U.S. Department of Health and Human Services Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic National Institutes
More informationPre-ALLHAT Drug Use. Diuretics. ß-Blockers. ACE Inhibitors. CCBs. Year. % of Treated Patients on Medication. CCBs. Beta Blockers.
Pre- Drug Use % of Treated Patients on Medication 60 50 40 30 20 10 0 1978 Diuretics ß-Blockers ACE Inhibitors Year CCBs CCBs Beta Blockers Diuretics ACE Inhibitors 1980 1982 1984 1986 1988 1990 1992 IMS
More informationHypertension Update Clinical Controversies Regarding Age and Race
Hypertension Update Clinical Controversies Regarding Age and Race Allison Helmer, PharmD, BCACP Assistant Clinical Professor Auburn University Harrison School of Pharmacy July 22, 2017 DISCLOSURE/CONFLICT
More informationDisclosure. No relevant financial relationships. Placebo-Controlled Statin Trials
PREVENTING CARDIOVASCULAR DISEASE IN WOMEN: Current Guidelines for Hypertension, Lipids and Aspirin Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial
More informationHypertension Guidelines: Are We Pressured to Change? Oregon Cardiovascular Symposium Portland, Oregon June 6, Financial Disclosures
Hypertension Guidelines: Are We Pressured to Change? Oregon Cardiovascular Symposium Portland, Oregon June 6, 2015 William C. Cushman, MD Professor, Preventive Medicine, Medicine, and Physiology University
More informationJNC Evidence-Based Guidelines for the Management of High Blood Pressure in Adults
JNC 8 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults Table of Contents Why Do We Treat Hypertension? Blood Pressure Treatment Goals Initial Therapy Strength of Recommendation
More informationWe are delighted to have Dr. Roetzheim with us today to discuss Managing Hypertension in Older Adult Patients.
Richard Roetzheim, MD, MSPH is Professor and Chair, Department of Family Medicine at the University of South Florida Morsani College of Medicine. Dr. Roetzheim has considerable experience leading NIH funded
More informationJNC 8 -Controversies. Sagren Naidoo Nephrologist CMJAH
JNC 8 -Controversies Sagren Naidoo Nephrologist CMJAH Joint National Committee (JNC) Panel appointed by the National Heart, Lung, and Blood Institute (NHLBI) First guidelines (JNC-1) published in 1977
More informationDISCLOSURES OUTLINE OUTLINE 9/29/2014 ANTI-HYPERTENSIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE
ANTI-HYPERTENSIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE DISCLOSURES Editor-in-Chief- Nephrology- UpToDate- (Wolters Klewer) Richard J. Glassock, MD, MACP Geffen School of Medicine at UCLA 1 st Annual Internal
More informationHealth Aging. Xaviour Walker MD, MPH, DTMH UCI Geriatric Fellow Hospitalist, Public Health and Preventive Medicine Physician
Health Aging Xaviour Walker MD, MPH, DTMH UCI Geriatric Fellow Hospitalist, Public Health and Preventive Medicine Physician What is Healthy Aging? Charles Eugster 96 years young! Stanislaw Kowalski 104
More informationThe Latest Generation of Clinical
The Latest Generation of Clinical Guidelines: HTN and HLD Dave Brackett Clinical Guideline Purpose Uniform approach Awareness of key details Diagnosis Treatment Monitoring Evidence based approach Inform
More informationALLHAT. Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic
1 U.S. Department of Health and Human Services National Institutes of Health Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker
More informationScreening for Lung Cancer: U.S. Preventive Services Task Force Recommendation. Hot Off the Press and into Your Practice: The Last Year in Medical News
Hot Off the Press and into Your Practice: The Last Year in Medical News Screening for Lung Cancer: U.S. Preventive Services Task Force Recommendation Moyer VA, et al. Ann Internal Med. 2014;160(5):330-338.
More informationManaging Hypertension in 2018
MANAGING HYPERTENSION IN 2018 How Do We Work With Conflicting Data and Conflicting Guidelines? Disclosure No relevant financial relationships Robert B. Baron, MD MS Professor and Associate Dean UCSF School
More informationBest Practices in Cardiac Care: Getting with the Guidelines
Best Practices in Cardiac Care: Getting with the Guidelines December 9, 2014 Agenda Cardiovascular Disease: How do the guidelines fit into an implementation scheme? What the guidelines set out to accomplish
More informationScreening for Colorectal Cancer in the Elderly. The Broad Perspective
Screening for Colorectal Cancer in the Elderly Charles J. Kahi, MD, MSCR Indiana University School of Medicine Richard L. Roudebush VA Medical Center Indianapolis, Indiana ACG Regional Midwest Course Symposium
More informationHypertension: 2016 Clinical Update
PHASE Safety Net Community Benefit Hypertension: 2016 Clinical Update Presented by: Joseph Young, MD Hypertension Clinical Lead Kaiser Permanente Northern California October 6, 2016 Dr. Joseph Young Hypertension
More informationHypertension. Does it Matter What Medications We Use? Nishant K. Sekaran, M.D. M.Sc. Intermountain Heart Institute
Hypertension Does it Matter What Medications We Use? Nishant K. Sekaran, M.D. M.Sc. Intermountain Heart Institute Hypertension 2017 Classification BP Category Systolic Diastolic Normal 120 and 80 Elevated
More informationPHASE Preventing Heart Attacks & Strokes Everyday
PHASE Preventing Heart Attacks & Strokes Everyday Welcome to the PHASE Learning Community! Joseph D. Young, MD Kaiser Permanente Northern California Jean Nudelman Kaiser Permanente Northern California
More informationTodd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM
Todd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM Faculty Disclosure I have no financial interest to disclose No off-label use of medications will be discussed FIFTH ANNUAL SYMPOSIUM Recognize changes between
More informationAkash Ghai MD, FACC February 27, No Disclosures
Akash Ghai MD, FACC February 27, 2015 No Disclosures Epidemiology Lifetime risk is > 20% for American s older than 40 years old. > 650,000 new cases diagnosed each year. Incidence increases with age: 2%
More informationLong-Term Care Updates
Long-Term Care Updates August 2015 By Darren Hein, PharmD Hypertension is a clinical condition in which the force of blood pushing on the arteries is higher than normal. This increases the risk for heart
More informationManagement of Hypertension in Women
Management of Hypertension in Women Eliseo J. Pérez-Stable MD Professor of Medicine DGIM, Department of Medicine July 1, 2013 Declaration of full disclosure: No conflict of interest (I have never been
More informationWhat s In the New Hypertension Guidelines?
American College of Physicians Ohio/Air Force Chapters 2018 Scientific Meeting Columbus, OH October 5, 2018 What s In the New Hypertension Guidelines? Max C. Reif, MD, FACP Objectives: At the end of the
More informationEgyptian Hypertension Guidelines
Egyptian Hypertension Guidelines 2014 Egyptian Hypertension Guidelines Dalia R. ElRemissy, MD Lecturer of Cardiovascular Medicine Cairo University Why Egyptian Guidelines? Guidelines developed for rich
More informationHypertension and Diabetes Should we be SPRINTING or Reaching an ACCORD?
Hypertension and Diabetes Should we be SPRINTING or Reaching an ACCORD? Suzanne Oparil, MD Distinguished Professor of Medicine, Professor of Cell, Developmental and Integrative Biology Director, Vascular
More informationHypertension Management: A Moving Target
9:45 :30am Hypertension Management: A Moving Target SPEAKER Karol Watson, MD, PhD, FACC Presenter Disclosure Information The following relationships exist related to this presentation: Karol E. Watson,
More informationHeart Failure Clinician Guide JANUARY 2018
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Heart Failure Clinician Guide JANUARY 2018 Introduction This evidence-based guideline summary is based on the 2018 National Heart Failure Guideline.
More informationAdult Hypertension Clinical Practice Guidelines
NATIONAL CLINICAL PRACTICE GUIDELINES Adult Hypertension Clinical Practice Guidelines Reviewed/Approved by the National Guideline Directors: November 2016 Next Review/Approval: November 2018 Developed
More informationHypertension 2015: Recent Evidence that Will Change Your Practice
Hypertension 2015: Recent Evidence that Will Change Your Practice Gerald W. Smetana, M.D. Division of General Medicine Beth Israel Deaconess Medical Center Professor of Medicine Harvard Medical School
More informationHypertension Update 2009
Hypertension Update 2009 New Drugs, New Goals, New Approaches, New Lessons from Clinical Trials Timothy C Fagan, MD, FACP Professor Emeritus University of Arizona New Drugs Direct Renin Inhibitors Endothelin
More informationObjectives. JNC 7 Is Nice But What s Up With JNC 8? Why Do We Care? Hypertension Background: Prevalence
JNC 7 Is Nice But What s Up With JNC 8? 37 th Annual CAPA Conference October 4 th 2013 Ignacio de Artola, Jr. M.D. Assistant Professor of Clinical Family Medicine Medical Director, Primary Care Physician
More informationALLHAT. ALLHAT Antihypertensive Trial Results by Baseline Diabetic & Fasting Glucose Status
ALLHAT Antihypertensive Trial Results by Baseline Diabetic & Fasting Glucose Status 1 Introduction and Background Clinical trials have reported reduction in CV events with diuretics, CCBs, ACE inhibitors,
More informationHypertension Management Controversies in the Elderly Patient
Hypertension Management Controversies in the Elderly Patient Juan Bowen, MD Geriatric Update for the Primary Care Provider November 17, 2016 2016 MFMER slide-1 Disclosure No financial relationships No
More informationBrent M. Egan, MD Professor of Medicine USCSOM Greenville
Contemporary Management of Uncontrolled and Treatment Resistant Hypertension Brent M. Egan, MD Professor of Medicine USCSOM Greenville Disclosures (past 3 years): Honoraria: BCBSSC, Medtronic Grant Support:
More informationUpdate in Cardiology Pharmacologic Management of Cardiovascular Risk. Christopher C. Roe, MSN, ACNP
Update in Cardiology Pharmacologic Management of Cardiovascular Risk Christopher C. Roe, MSN, ACNP Objectives 1. Verbalize understanding of new pharmacologic guidelines in the treatment of hypertension
More informationInt. J. Pharm. Sci. Rev. Res., 36(1), January February 2016; Article No. 06, Pages: JNC 8 versus JNC 7 Understanding the Evidences
Research Article JNC 8 versus JNC 7 Understanding the Evidences Anns Clara Joseph, Karthik MS, Sivasakthi R, Venkatanarayanan R, Sam Johnson Udaya Chander J* RVS College of Pharmaceutical Sciences, Coimbatore,
More informationHeart Failure Clinician Guide JANUARY 2016
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Heart Failure Clinician Guide JANUARY 2016 Introduction This evidence-based guideline summary is based on the 2016 National Heart Failure Guideline.
More informationAPPENDIX D: PHARMACOTYHERAPY EVIDENCE
Página 1 de 7 APPENDIX D: PHARMACOTYHERAPY EVIDENCE Table D1. Outcome Trials of Antihypertensive Agents Study Drug Regimen N Duration Primary Outcomes Remarks Antihypertensive Therapy vs Placebo SHEP 1991
More informationALLHAT Role of Diuretics in the Prevention of Heart Failure - The Antihypertensive and Lipid- Lowering Treatment to Prevent Heart Attack Trial
1 ALLHAT Role of Diuretics in the Prevention of Heart Failure - The Antihypertensive and Lipid- Lowering Treatment to Prevent Heart Attack Trial Davis BR, Piller LB, Cutler JA, et al. Circulation 2006.113:2201-2210.
More informationJared Moore, MD, FACP
Hypertension 101 Jared Moore, MD, FACP Assistant Program Director, Internal Medicine Residency Clinical Assistant Professor of Internal Medicine Division of General Medicine The Ohio State University Wexner
More informationClinical Updates in the Treatment of Hypertension JNC 7 vs. JNC 8. Lauren Thomas, PharmD PGY1 Pharmacy Practice Resident South Pointe Hospital
Clinical Updates in the Treatment of Hypertension JNC 7 vs. JNC 8 Lauren Thomas, PharmD PGY1 Pharmacy Practice Resident South Pointe Hospital Objectives Review the Eighth Joint National Committee (JNC
More informationPage 1. Selected Controversies. Cancer Screening! Selected Controversies. Breast Cancer Screening. ! Using Best Evidence to Guide Practice!
Cancer Screening!! Using Best Evidence to Guide Practice! Judith M.E. Walsh, MD, MPH! Division of General Internal Medicine! Womenʼs Health Center of Excellence University of California, San Francisco!
More informationNew Hypertension Guidelines. Kofi Osei, MD
New Hypertension Guidelines Kofi Osei, MD None Disclosures Objectives The new blood pressure definitions and cardiovascular risk The role to time and location in the diagnosis of hypertension Apply evidence-based
More informationNo relevant financial relationships
MANAGEMENT OF LIPID DISORDERS Balancing Benefits and harms Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial relationships baron@medicine.ucsf.edu
More informationOutline. Outline 10/14/2014 CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW. Question 1: Which of these patients has CKD?
CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,
More informationFrom PARADIGM-HF to Clinical Practice. Waleed AlHabeeb, MD, MHA Associate Professor of Medicine President of the Saudi Heart Failure Group
From PARADIGM-HF to Clinical Practice Waleed AlHabeeb, MD, MHA Associate Professor of Medicine President of the Saudi Heart Failure Group PARADIGM-HF: Inclusion Criteria Chronic HF NYHA FC II IV with LVEF
More informationDisclosures. Hypertension: Nationwide Dilemma. Learning Objectives. What s Currently Recommended? Specific Concerns 3/9/2012
How Should We ACCOMPLISH Good Blood Pressure Control In Our VETS? Disclosures No conflicts of interest to disclose Updates in the Management of HypertensionIn the Elderly Antoine T. Jenkins, Pharm.D.,
More informationSelected Controversies. Cancer Screening. Breast Cancer Screening. Selected Controversies. Page 1. Using Best Evidence to Guide Practice
Cancer Screening Using Best Evidence to Guide Practice Judith M.E. Walsh, MD, MH Division of General Internal Medicine Women s Health Center of Excellence University of California, San Francisco Selected
More informationNew Hypertension Guideline Recommendations for Adults July 7, :45-9:30am
Advances in Cardiovascular Disease 30 th Annual Convention and Reunion UERM-CMAA, Inc. Annual Convention and Scientific Meeting July 5-8, 2018 New Hypertension Guideline Recommendations for Adults July
More information4/4/17 HYPERTENSION TARGETS: WHAT DO WE DO NOW? SET THE STAGE BP IN CLINICAL TRIALS?
HYPERTENSION TARGETS: WHAT DO WE DO NOW? MICHAEL LEFEVRE, MD, MSPH PROFESSOR AND VICE CHAIR DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE UNIVERSITY OF MISSOURI 4/4/17 DISCLOSURE: MEMBER OF THE JNC 8 PANEL
More informationStatus of the CKD and ESRD treatment: Growth, Care, Disparities
Status of the CKD and ESRD treatment: Growth, Care, Disparities United States Renal Data System Coordinating Center An J. Collins, MD FACP Director USRDS Coordinating Center Robert Foley, MB Co-investigator
More informationHypertension targets: sorting out the confusion. Brian Rayner, Division of Nephrology and Hypertension, University of Cape Town
Hypertension targets: sorting out the confusion Brian Rayner, Division of Nephrology and Hypertension, University of Cape Town Historical Perspective The most famous casualty of this approach was the
More informationScreening for Lung Cancer: U.S. Preventive Services Task Force Recommendation. Hot Off the Press and into Your Practice: The Last Year in Medical News
Presenter Disclosure Information 1:45 3pm Hot Off the Press and Into Your Practice 2014 The following relationships exist related to this presentation: Michael J. Bloch, MD, FACP, FASH, receives consulting
More informationHYPERTENSION IN THE ELDERLY A BALANCED APPROACH. Barry Goldlist October 31, 2014
HYPERTENSION IN THE ELDERLY A BALANCED APPROACH Barry Goldlist October 31, 2014 DISCLOSURE I have not accepted any money for myself from any pharmaceutical company in the 21 st century I have accepted
More informationHypertension JNC 8 (2014)
Hypertension JNC 8 (2014) Renewed: February 2018 Updated: February 2015 Comparison of Seventh Joint National Committee (JNC 7) vs. Eighth Joint National Committee (JNC 8) Hypertension Guidelines Methodology
More informationRandomized Design of ALLHAT BP Trial
Outcomes in Hypertensive Black and Nonblack Patients Treated with Chlorthalidone, Amlodipine, and Lisinopril* *Wright JT, Dunn JK, Cutler JA et al. JAMA 2005:293:1595-1608. 42,418 High-risk hypertensive
More informationManagement of High Blood Pressure in Adults
Management of High Blood Pressure in Adults Based on the Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC8) James, P. A. (2014, February 05). 2014 Guideline for Management
More informationUpdate in Cardiology What s Hot in 2017?
Update in Cardiology What s Hot in 2017? Mark R. Milunski, MD, FACC, FACP Chief, Cardiology Section Orlando Veterans Affairs Medical Center Associate Professor of Medicine University of Central Florida
More informationNew Recommendations for the Treatment of Hypertension: From Population Salt Reduction to Personalized Treatment Targets
New Recommendations for the Treatment of Hypertension: From Population Salt Reduction to Personalized Treatment Targets Sidney C. Smith, Jr. MD, FACC, FAHA Professor of Medicine/Cardiology University of
More informationOCTOBER 7-10 PHILADELPHIA, PENNSYLVANIA
OMED 17 OCTOBER 7-10 PHILADELPHIA, PENNSYLVANIA 29.5 Category 1-A CME credits anticipated ACOFP / AOA s 122 nd Annual Osteopathic Medical Conference & Exposition ACOFP - The Heart of the Matter - An Evidence
More informationCongestive Heart Failure: Outpatient Management
The Chattanooga Heart Institute Cardiovascular Symposium Congestive Heart Failure: Outpatient Management E. Philip Lehman MD, MPP Disclosure No financial disclosures. Objectives Evidence-based therapy
More informationPage 1. Cancer Screening for Women I have no conflicts of interest. Overview. Breast, Colon, and Lung Cancer. Jeffrey A.
Cancer Screening for Women 2017 Breast, Colon, and Lung Cancer Jeffrey A. Tice, MD Professor of Medicine Division of General Internal Medicine University of California, San Francisco I have no conflicts
More informationOutline. Outline CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW. Question 1: Which of these patients has CKD?
CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,
More informationHypertension Update Warwick Jaffe Interventional Cardiologist Ascot Hospital
Hypertension Update 2008 Warwick Jaffe Interventional Cardiologist Ascot Hospital Definition of Hypertension Continuous variable At some point the risk becomes high enough to justify treatment Treatment
More informationManagement of Hypertension in special groups. DR-Mohammed Salah Assistant Lecturer of Cardiology Mansoura University
Management of Hypertension in special groups BY DR-Mohammed Salah Assistant Lecturer of Cardiology Mansoura University AGENDA SPECIAL GROUPS SPECIFIC DRUDS FOR SPECIAL GROUPS TARGET BP FOR SPECIAL GROUPS:
More informationControlling Hypertension in Primary Care: Hitting a moving target?
Controlling Hypertension in Primary Care: Hitting a moving target? David J. Hyman, MD,MPH Professor of Medicine and Family & Community Medicine Chief, Section General Medicine Baylor College of Medicine
More informationDifficult-to-Control & Resistant Hypertension. Anthony Viera, MD, MPH, FAHA Professor and Chair
Difficult-to-Control & Resistant Hypertension Anthony Viera, MD, MPH, FAHA Professor and Chair Objectives Define resistant hypertension Discuss evaluation strategy for patient with HTN that appears difficult
More informationHypertension and Cardiovascular Disease
Hypertension and Cardiovascular Disease Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or by any means graphic,
More informationHYPERTENSION MANAGEMENT IN ELDERLY POPULATIONS
HYPERTENSION MANAGEMENT IN ELDERLY POPULATIONS Michael J. Scalese, PharmD, BCPS, CACP Assistant Clinical Professor Auburn University Harrison School of Pharmacy July 14, 2018 DISCLOSURE/CONFLICT OF INTEREST
More informationPhysician Follow-Up and Guideline Adherence in Post- Treatment Surveillance of Colorectal Cancer
Physician Follow-Up and Guideline Adherence in Post- Treatment Surveillance of Colorectal Cancer Gabriela M. Vargas, MD Kristin M. Sheffield, PhD, Abhishek Parmar, MD, Yimei Han, MS, Kimberly M. Brown,
More informationObjectives. Definitions. Colorectal Cancer Screening 5/8/2018. Payam Afshar, MS, MD Kaiser Permanente, San Diego. Colorectal cancer background
Colorectal Cancer Screening Payam Afshar, MS, MD Kaiser Permanente, San Diego Objectives Colorectal cancer background Colorectal cancer screening populations Colorectal cancer screening modalities Colonoscopy
More informationCreative blood pressure management: whys and the tricks
Creative blood pressure management: whys and the tricks Cynthia D. Caraballo-Hunt, MD Kaiser/OHSU Family Medicine Faculty Beaverton Medical Office NW Permanente, Portland, OR Objectives 1. Describe current
More informationColorectal Cancer Screening: Cost-Effectiveness and Adverse events October, 2005
Colorectal Cancer Screening: Cost-Effectiveness and Adverse events October, 2005 David Lieberman MD Chief, Division of Gastroenterology Oregon Health and Science University Portland VAMC Portland, Oregon
More informationDifficult to Treat Hypertension
Difficult to Treat Hypertension According to Goldilocks JNC 8 Blood Pressure Goals (2014) BP Goal 60 years old and greater*- systolic < 150 and diastolic < 90. (Grade A)** BP Goal 18-59 years old* diastolic
More informationDo Women Benefit From Statins for Primary Prevention?: Controversy, Challenges and Consensus
Do Women Benefit From Statins for Primary Prevention?: Controversy, Challenges and Consensus C. Noel Bairey Merz MD, FACC, FAHA Professor and Women s Guild Endowed Chair Director, Barbra Streisand Women
More informationALLHAT RENAL DISEASE OUTCOMES IN HYPERTENSIVE PATIENTS STRATIFIED INTO 4 GROUPS BY BASELINE GLOMERULAR FILTRATION RATE (GFR)
1 RENAL DISEASE OUTCOMES IN HYPERTENSIVE PATIENTS STRATIFIED INTO 4 GROUPS BY BASELINE GLOMERULAR FILTRATION RATE (GFR) 6 / 5 / 1006-1 2 Introduction Hypertension is the second most common cause of end-stage
More information