Management of Hypertension in the Diabetic Patient:
|
|
|
- Avis Francis
- 5 years ago
- Views:
Transcription
1 Management of Hypertension in the Diabetic Patient: Nicolas W. Shammas, MS, MD Research Director, Cardiovascular Medicine, PC
2 Presentation Objectives To review: The relationship between HTN, insulin resistance and CV risk factors The importance of HbA 1c, and MAU as surrogate markers of CV outcomes Treatment of hypertension in a diabetic patient with and without congestive heart failure HTN=hypertension; DM=diabetes mellitus; CV=cardiovascular; MAU=microalbuminuria; BP=blood pressure
3 Presentation Objectives To review: The relationship between HTN, insulin resistance and CV risk factors The importance of HbA 1c, and MAU as surrogate markers of CV outcomes Treatment of hypertension in a diabetic patient with and without congestive heart failure HTN=hypertension; DM=diabetes mellitus; CV=cardiovascular; MAU=microalbuminuria; BP=blood pressure
4 Insulin Resistance and Cardiovascular Risk factors Increased Peritoneal Fat Production of Excess Adipocytokines Diabetes Insulin Resistance Uric Acid Hyperinsulinemia Dyslipidemia Endothelial Dysfunction Albuminuria PAI 1 CRP HDL HDL 2 TG ApoB Small-Dense LDL CV Events LVH HTN Platelet Aggregation PAI=plasminogen activator inhibitor Bell DSH. J Gender-Specific Med. 2002;5:1-14.
5 CVD Risk Factors HTN* Cigarette smoking Obesity* (BMI 30 kg/m 2 ) Physical inactivity Dyslipidemia* DM* MAU Estimated GFR <60 ml/min Age (men >55, women >65) Family history of premature cardiovascular disease (CVD) (for men <55, women <65) *Components of the metabolic syndrome. Chobanian AV, et al. JNC 7 Report. JAMA. 2003;289:
6 Association of CV Risk Factors and the Prediabetic Patient :San Antonio Heart Study P<.01 Patients With No Diabetes at Follow-up (n=1,539) Patients With Diabetes at Follow-up (n=195) 160 Units P<.01 P<.01 P< P<.01 P< BMI (kg/m 2 ) TG (mg/dl) * HDL-C (mg/dl) SBP (mm Hg) Fasting Glucose Fasting (mg/dl) Insulin (pmol) Haffner SM, et al. Circulation. 2000;101:
7 Hypertensive Diabetics are at risk of Congestive Heart Failure and MI ACE Inhibition β-blockade SNS-RAS HTN SNS-RAS ACE Inhibition β-blockade MI Metabolic Syndrome/Diabetes Cardiomyopathy HF Adams KF, et al. Pharmacotherapy. 2000;20: Fonarow GC. Rev Cardiovasc Med. 2003;4:S38-S49.
8 How to assess the cardiovascular risk of a diabetic in an easily measurable way and how to treat hypertension in a diabetic?
9 Presentation Objectives To review: The relationship between HTN and insulin resistance, DM, and risk for CV events The importance of HbA 1c, and MAU as surrogate markers of CV outcomes Treatment of hypertension in a diabetic patient with and without congestive heart failure
10 Surrogate Endpoints of Adverse Cardiovascular Outcomes in a Diabetic HBA1C
11 UKPDS: MI and Microvascular Endpoints and the Association With Mean HbA 1c Concentration 80 Adjusted Incidence per 1,000 Person-Years (%) MI Microvascular Endpoints Updated Mean HbA 1c Concentration (%) Stratton IM, et al. BMJ. 2000;321:
12 EPIC-Norfolk Study: Every 1% Increase in HbA 1c Increased CV Risk Increase in Relative Risk (%)* % Increase in HbA 1c Above 5% 1% Increase in HbA 1c Above 7% Men Women 40% 28% 40 25% 24% 21% 20% 21% 30 26% Increase in Relative Risk (%) % 0 CHD CVD Total Mortality CHD CVD Total Mortality 0 CHD CVD Total Mortality EPIC-Norfolk: The European Prospective Investigation into Cancer in Norfolk. Khaw KT, et al. Ann Intern Med. 2004;141:
13 The Need for Tight Glycemic Control According to UKPDS 35, every 1% relative drop in HbA 1c was associated with: 21% 14% 12% 16% Decrease in any diabetesrelated endpoint P<.0001 Decrease in risk of MI P<.0001 Decrease in risk of stroke P=.035 Decrease in risk of HF P=.016 United Kingdom Prospective Diabetes Study (UKPDS) 35 Stratton IM, et al. BMJ. 2000;321: % Decrease in risk of microvascular complications P<.0001
14 EPIC-Norfolk Study: Even Small Absolute Changes in HbA 1c May Impact Mortality Patients with HbA 1c * 0.1% decrease in HbA 1c may result in: 0.2% decrease in HbA 1c may result in: 12% 25% Reduction in Mortality Khaw KT, et al. BMJ. 2001:322:15-18.
15 Surrogate Endpoints of Adverse Cardiovascular Outcomes in a Diabetic MAU
16 HOPE: Association of MAU With CV Events in Patients With Diabetes MAU present MAU not present Patients (%) MI, Stroke, or CV Death HF Hospitalization All-Cause Mortality Gerstein HC, et al. JAMA. 2001;286:
17 HOPE: Independent Predictive Variables for Combined Endpoints of CV Death, MI, and Stroke Variable MAU CAD PVD DM Creatinine >1.4 mg/dl Male WHR Every one year increase in age Hazard Ratio WHR=waist to hip ratio. Mann JFE, et al. Ann Intern Med. 2001;134:
18 EPIC-Norfolk: MAU Independently Associated With Mortality Mortality Due to: Stroke Cardiovascular Coronary Heart Disease All-Cause Hazard Ratio Associated With MAU 1.58* % CI 1.01, , , , 1.79 Yuyun MF, et al. Int J Epidemiol. 2004;33:
19 Proteinuria Predicted CV Mortality, Stroke, and CHD Events in Type 2 Diabetes A: U-Prot <150 mg/l B: U-Prot mg/l C: U-Prot >300 mg/l 1 CV Mortality 40 A vs C: P<.001 Survival P Values: A vs B: <.013 A vs C: <.001 B vs C: <.001 A B C Incidence (%) A vs C: P< Months Prospective study of 1,056 diabetic patients aged followed for 7 years. U-Prot=urinary protein concentration. Miettinen H, et al. Stroke. 1996;27: Stroke CHD Events
20 MAU Compared With Traditional Risk Factors for IHD 3 P=.0004 Relative Risk P=.002 P= P< P=.004 Smoking MAU Male Gender Total Cholesterol SBP A/C ratio >.65 mg/mmol >7.0 mmol/l >160 mm Hg Borch-Johnsen K, et al. Arterioscler Thromb Vasc Biol. 1999;19:
21 PREVEND: Predicted Prevalence of MAU According to CRP and MAP Prevalence of MAU (%) BMI: Mean age: 51 1/3 smokers CRP 10 mg/l CRP 3 mg/l CRP 1 mg/l CRP.2 mg/l Mean Arterial Pressure (mm Hg) Stuveling EM, et al. Hypertension. 2004;43:
22 Presentation Objectives To review: The relationship between HTN and insulin resistance, DM, and risk for CV events The importance of HbA 1c, and MAU as surrogate markers of CV outcomes Treatment of hypertension in a diabetic patient with and without congestive heart failure
23 NHANES: Diabetic Adults Who Achieved Recommended Vascular Risk Factor Goals 100 NHANES III (N=1,204) NHANES (N=370) 90 Diabetic Adults (%) HbA 1c <7% BP <130/80 mm Hg TC <200 mg/dl Good Control Saydah S, et al. JAMA. 2004;291:
24 High-Risk Hypertensive Patients Require Multiple Agents to Achieve Goal Achieved SBP AASK 1 ABCD 2,3 ALLHAT 4 HOT 2,5 IDNT 6 (134 mm Hg) (132 mm Hg) (135 mm Hg) (141 mm Hg) (140 mm Hg) RENAAL 7 (140 mm Hg) UKPDS 2,8 (144 mm Hg) Number of BP Medications
25 JNC 7: Antihypertensive Drug Classes for High-Risk Hypertensive Conditions High-Risk Condition With Compelling Indication Diuretic β-blocker ACE Inhibitor ARB CCB Aldosterone Antagonist Clinical Trial Basis HF ACC/AHA Heart Failure Guidelines, MERIT-HF, COPERNICUS, CIBIS, SOLVD, AIRE, TRACE, Val-HeFT, RALES Post-MI ACC/AHA Post-MI Guidelines, BHAT, SAVE, CAPRICORN, EPHESUS High Coronary Disease Risk ALLHAT, HOPE, ANBP2, LIFE, CONVINCE Diabetes NKF-ADA Guidelines,UKPDS, ALLHAT Chronic Kidney Disease Recurrent Stroke Prevention NKF Guidelines, Captopril Trial, RENAAL, IDNT, REIN, AASK PROGRESS JNC 7 Report. JAMA. 2003;289:
26 Algorithm for treating BP in the diabetic hypertensive patient BP BP >150 ACEI/ ARB ACEI/ARB + low dosethiazide diuretic Low dose thiazide diuretic Beta blocker Evaluate for secondary causes of HT (RAS) CCB
27 Effect of β-blockade on Fasting Glucose and HbA 1c in Hypertensive Patients Fasting Plasma Glucose HbA 1c Insulin Sensitivity Index (M/I)* (mmol/l) P=NS (%) P=.04 (M value/mu/l 100) % P= Baseline After 1 yr of Metoprolol Succinate 5.2 Baseline After 1 yr of Metoprolol Succinate 4 Baseline After 1 yr of Metoprolol Succinate 24 hypertensive patients age years were treated with 200 mg of metoprolol succinate for one year. Haenni A. Metabolism. 1994;43:
28 Carvedilol: Metabolic Parameters in Diabetic Hypertensive Patients (mg/dl)* Glucose Level Baseline (%) Months HbA 1c Level (pmol/l) Insulin Level % Change From Baseline at 6 Months 4% 2% 0% -2% -3-4% Glucose Level 5% 4% 3% 2% 1% 0% -1% -2% -3% -4% -5% -1% HbA 1c Level 12% 6% 0% -6% -12% -10 Insulin Level Giugliano D. Ann Intern Med. 1997;126:
29 The GEMINI Trial Glycemic Effects in Diabetes Mellitus: CarvedIlol Metoprolol Tartrate ComparisoN in HypertensIves
30 Background β-blockers decrease cardiovascular risk in patients with HTN and type 2 diabetes However, many metabolic syndrome components (eg, glucose and lipids) are worsened by most β-blockers β-blockers are commonly used with agents such as renin-angiotensin system blockers, which are known to improve insulin resistance, and therefore may diminish these adverse metabolic effects Bakris, et al. JAMA. 2004;292:
31 Objectives To compare two β-blockers with different pharmacological profiles On glycemic and metabolic control In participants with type 2 diabetes and HTN In the presence of agents known to improve insulin resistance (eg, renin-angiotensin system blockers) To assess differences in impact of treatment on cardiovascular risk factors Bakris, et al. JAMA. 2004;292:
32 Inclusion Criteria History of Stage 1 or Stage 2 HTN treated with an ACE inhibitor or ARB, and Type 2 diabetes Baseline HbA 1c 6.5%-8.5%, and C-peptide >.6 ng/ml Bakris, et al. JAMA. 2004;292:
33 Study Design Randomized, double-blind, parallel-group, multicenter, US trial BP target values defined by ADA/NKF Guidelines and updated in 2001 Randomized agents were titrated to achieve BP targets based on Prescribing Information (PDR) Carvedilol: 6.25, 12.5, 25 mg BID Metoprolol tartrate: 50, 100, 200 mg BID Blinded therapy was maintained for five additional months following titration to target BP
34 Primary and Secondary Analyses Primary Analysis The difference in HbA 1c change from baseline between the Carvedilol and metoprolol tartrate groups using a modified intention-to-treat analysis Secondary Analyses: Prespecified Endpoints Metabolic HbA 1c change from baseline (within groups) Insulin resistance by HOMA Withdrawals for worsening glycemic control Lipids Cardiovascular BP Albumin:creatinine ratio MAU HOMA=homeostasis model assessment. Bakris, et al. JAMA. 2004;292:
35 GEMINI GEMINI did not have clinical outcomes as primary endpoint but surrogate markers of clinical outcomes In the GEMINI study, metoprolol succinate, which is the generic name of Toprol-XL * extended-release tablets, was not studied
36 Baseline Characteristics Age, mean (SD), years Female, n (%) BMI, mean (SD), kg/m 2 Race/ethnicity, n (%) White Black Asian Hispanic Other/multiracial Carvedilol (n=498) 60.7 (9.4) 198 (39.8) 33.5 (5.8) 382 (76.7) 62 (12.4) 20 (4.0) 31 (6.2) 3 (.6) Metoprolol Tartrate (n=737) 61.1 (9.7) 354 (48.0) 33.7 (6.2) 548 (74.4) 105 (14.2) 23 (3.1) 55 (7.5) 6 (.8) BMI=body mass index. Bakris, et al. JAMA. 2004;292:
37 Baseline Characteristics C-peptide, mean (SD), nmol/l HbA 1c, mean (SD), % Baseline HbA 1c <7.0%, n (%) Antidiabetic medications (%) Sulfonylureas* Biguanides* Thiazolidinediones* Meglitinides* Multiple agents Insulin None Carvedilol (n=498) 1.12 (.53) 7.21 (.55) 191 (39%) 91 (18.3) 79 (15.9) 16 (3.2) 1 (.2) 260 (52.2) 40 (8.0) 40 (8.0) Metoprolol Tartrate (n=737) 1.14 (.54) 7.19 (.54) 285 (39%) 117 (15.9) 108 (14.7) 28 (3.8) 4 (.5) 414 (56.2) 60 (8.1) 57 (7.7) Bakris, et al. JAMA. 2004;292:
38 Blood Pressure and Heart Rate SBP, mm Hg DBP, mm Hg Treatment Difference (Coreg vs Metoprolol Tartrate) Change (95% CI) -1.0 (-2.60, -.58).29 (-.61, 1.20) P Value HR, beats/min 1.6 (.70, 2.58) < Baseline Month 5 Baseline Month 5 Baseline Month 5 Mean SBP (mm Hg) Mean DBP (mm Hg) Mean HR (beats/min) Coreg (n=454) Metoprolol Tartrate (n=636) Bakris, et al. JAMA. 2004;292: Data on file. GlaxoSmithKline.
39 Treatment Duration and Doses Achieved Treatment duration (days ± SD)* Patients completing 5 months of maintenance therapy Mean dose to achieve target BP Carvedilol (n=498) 155 ± 52 80% 17.5 mg BID Metoprolol Tartrate (n=737) 147 ± 60 74% 128 mg BID Agents titrated to achieve target BP based on Prescribing Information. Bakris, et al. JAMA. 2004;292: Data on file. GlaxoSmithKline.
40 Patients Achieving BP <130/80 mm Hg Patients (%) / / / /636 Coreg Metoprolol Tartrate Post-hoc analysis. Bakris, et al. JAMA. 2004;292:
41 Fasting Glucose mg/dl P=.002 P<.0001 Baseline Month 5 Baseline Month 5 Metoprolol Tartrate (carvedilol=419) (n=607) Treatment Difference Coreg vs Metoprolol 4.0 ( 8.73,.78) P=.10 Bakris, et al. JAMA. 2004;292: Data on file. GlaxoSmithKline.
42 Hemoglobin A 1c 7.4 P<.0001 Mean HbA 1c (%) P=.65 Treatment Difference Coreg vs Metoprolol.13% (.22,.04) P= Baseline Month 5 Baseline Month 5 Carvedilol (n=454) Metoprolol Tartrate (n=657)
43 Insulin Resistance by HOMA 6.3 P=NS mcu/ml*mmol/l P=.004 Treatment Difference Coreg vs Metoprolol 7.2% (13.8,.20) P=.04 (Analysis of geometric means; log-transformed data) Baseline Month 5 Carvedilol (n=371) Baseline Month 5 Metoprolol Tartrate (n=540) HOMA=homeostasis model assessment. Bakris, et al. JAMA. 2004;292:
44 Albumin:Creatinine Ratio Relative reduction, 16% (Coreg vs Metoprolol Tartrate) 95% CI (6, 25) P= Change (%) P=.003 Coreg (n=388) P=NS Metoprolol Tartrate (n=542) Bakris, et al. JAMA. 2004;292: Data on file. GlaxoSmithKline.
45 Development of MAU in Previously Normoalbuminuric Participants 16 Odds ratio,.53 95% CI (.30,.93) P=.03 Patients (%) Coreg (n=302) Metoprolol Tartrate (n=431) Bakris, et al. JAMA. 2004;292:
46 Total Cholesterol P<.001 P=.5 mg/dl Treatment Difference Coreg vs Metoprolol 2.9% ( 4.6, 1.15) P= Baseline Month 5 Baseline Month 5 Coreg (n=433) Metoprolol Tartrate (n=625) Bakris, et al. JAMA. 2004;292: Data on file. GlaxoSmithKline.
47 Triglycerides 190 P< mg/dl P=.3 Treatment Difference Coreg vs Metoprolol 9.8% ( 13.7, 5.8) P< Baseline Month 5 Baseline Month 5 Coreg (n=433) Metoprolol Tartrate (n=625) Bakris, et al. JAMA. 2004;292: Data on file. GlaxoSmithKline.
48 New Statin Initiation or Dose Increase 6 5 Odds ratio,.48 95% CI (.24,.97) P= Patients (%) Coreg (n=459) Metoprolol Tartrate (n=659) Bakris, et al. JAMA. 2004;292: Data on file. GlaxoSmithKline.
49 Withdrawals for Worsening Glycemic Control* 2.5 P=.04 Patients (%) / /498 Coreg Metoprolol Tartrate Bakris, et al. JAMA. 2004;292:
50 Weight Gain Mean Change from Baseline (kg) P=.36 Coreg (n=456) P<.001 Metoprolol Tartrate (n=650) Treatment Difference Coreg vs Metoprolol 1.0 ( 1.43,.60) P<.001 Bakris, et al. JAMA. 2004;292: Data on file. GlaxoSmithKline.
51 GEMINI: Conclusions GEMINI is the first large-scale randomized trial to evaluate the addition of β-blockade to ACE inhibition to achieve the recommended BP target of <130/80 mm Hg for patients with type 2 diabetes Similar BP levels were achieved with a mean total daily dose of 35 mg Coreg or 256 mg metoprolol tartrate on top of treatment with ACEI/ARB In these high cardiovascular risk patients, Carvedilol: Achieved BP goal Improved insulin resistance Improved MAU as measured by ACR Reduced progression to MAU
52 β-blockers in Diabetic Patients: Post-MI 100 Survival (%) No DM; β-blockers DM; β-blockers No DM; No β-blockers DM; No β-blockers Time (days) From a 2,024-patient study, 340 had diabetes, and 281 survived hospitalization for acute MI. Of the 127 patients with diabetes taking β-blockers, 80% received propranolol and 20% received other β-blockers. Kjekshus J, et al. Eur Heart J. 1990;11:43-50.
53 Consistent Effect of beta-blockade on Vascular Events in HF 20 Sudden Death Risk Reduction 19% (3%, 32%) P= Fatal or Nonfatal MI Risk Reduction 30% (1%, 50%) P= All-Cause Mortality in CAD Patients* Risk Reduction 17% (3.5%, 28%) P=.015 Mortality (%) Metoprolol (n=1,518) Coreg (n=1,511) Sudden death rates: metoprolol 17.3%, Coreg 14.4% Time (years) Event (%) Metoprolol (n=1,518) Coreg (n=1,511) Event rates: metoprolol 5.2%, Coreg 3.8% Time (years) Mortality (%) 25 0 Metoprolol (n=847) Coreg (n=823) All-cause mortality rates: metoprolol 46.9%, Coreg 40.1% Time (years) *Includes patients with documented MI, PTCA, CABG, or CAD by angiography or diagnosis of ischemic cardiomyopathy. 1 Poole-Wilson, PA et al. Lancet. 2003;362:7-13. Remme W. J Am Coll Cardiol. 2004;43:205A.
54 Conclusions Hypertension is a strong contributor to CV risk, particularly in diabetic patients. The goal should be: <= 125/85 Therapy for the diabetic hypertensive patient should include drugs that reduce CV risk such as ACEI and β- blockers Beta blockade might alter glucose levels, but α/β blockade with carvedilol in a randomized trial: Improved insulin resistance Improved MAU Reduced progression to MAU Beta blockade in the hypertensive diabetic, the post MI patient and the CHF patient is now an essential treatment
Combination Therapy for Hypertension
Combination Therapy for Hypertension Se-Joong Rim, MD Cardiology Division, Yonsei University College of Medicine, Seoul, Korea Goals of Therapy Reduce CVD and renal morbidity and mortality. Treat to BP
Hypertension Management Focus on new RAAS blocker. Disclosure
Hypertension Management Focus on new RAAS blocker Rameshkumar Raman M.D Endocrine Associates of The Quad Cities Disclosure Speaker bureau Abbott, Eli Lilly, Novo Nordisk, Novartis, Takeda, Merck, Solvay
Management of Hypertension. Ahmed El Hawary MD Suez Canal University
Management of Hypertension Ahmed El Hawary MD Suez Canal University Minimal vs. Optimal Care Resources more than science affect type of care and level of management. what is possible (minimal care) and
Cedars Sinai Diabetes. Michael A. Weber
Cedars Sinai Diabetes Michael A. Weber Speaker Disclosures I disclose that I am a Consultant for: Ablative Solutions, Boston Scientific, Boehringer Ingelheim, Eli Lilly, Forest, Medtronics, Novartis, ReCor
The 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
Treating Hypertension in Individuals with Diabetes
Treating Hypertension in Individuals with Diabetes 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
How to Reduce CVD Complications in Diabetes?
How to Reduce CVD Complications in Diabetes? Chaicharn Deerochanawong M.D. Diabetes and Endocrinology Unit Department of Medicine Rajavithi Hospital, Ministry of Public Health Framingham Heart Study 30-Year
Eugene Barrett M.D., Ph.D. University of Virginia 6/18/2007. Diagnosis and what is it Glucose Tolerance Categories FPG
Diabetes Mellitus: Update 7 What is the unifying basis of this vascular disease? Eugene J. Barrett, MD, PhD Professor of Internal Medicine and Pediatrics Director, Diabetes Center and GCRC Health System
The Diabetes Link to Heart Disease
The Diabetes Link to Heart Disease Anthony Abe DeSantis, MD September 18, 2015 University of WA Division of Metabolism, Endocrinology and Nutrition Oswald Toosweet Case #1 68 yo M with T2DM Diagnosed DM
Kidney Disease, Hypertension and Cardiovascular Risk
1 Kidney Disease, Hypertension and Cardiovascular Risk George Bakris, MD, FAHA, FASN Professor of Medicine Director, Hypertensive Diseases Unit The University of Chicago-Pritzker School of Medicine Chicago,
Lessons learned from AASK (African-American Study of Kidney Disease and Hypertension)
Lessons learned from AASK (African-American Study of Kidney Disease and Hypertension) Janice P. Lea, MD, MSc, FASN Professor of Medicine Chief Medical Director of Emory Dialysis ASH Clinical Specialist
Diabetes Mellitus: A Cardiovascular Disease
Diabetes Mellitus: A Cardiovascular Disease Nestoras Mathioudakis, M.D. Assistant Professor of Medicine Division of Endocrinology, Diabetes, & Metabolism September 30, 2013 1 The ABCs of cardiovascular
1. Albuminuria an early sign of glomerular damage and renal disease. albuminuria
1. Albuminuria an early sign of glomerular damage and renal disease albuminuria Cardio-renal continuum REGRESS Target organ damage Asymptomatic CKD New risk factors Atherosclerosis Target organ damage
Ischemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010
Ischemic Heart and Cerebrovascular Disease Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Relationships Between Diabetes and Ischemic Heart Disease Risk of Cardiovascular Disease in Different Categories
New Antihypertensive Strategies to Improve Blood Pressure Control
New Antihypertensive Strategies to Improve Blood Pressure Control Antonio Coca, MD, PhD,, FRCP, FESC Hypertension and Vascular Risk Unit Department of Internal Medicine. Hospital Clínic (IDIBAPS) University
Disclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease
Disclosures Diabetes and Cardiovascular Risk Management Tony Hampton, MD, MBA Medical Director Advocate Aurora Operating System Advocate Aurora Healthcare Downers Grove, IL No conflicts or disclosures
Kidney and heart: dangerous liaisons. Luis M. RUILOPE (Madrid, Spain)
Kidney and heart: dangerous liaisons Luis M. RUILOPE (Madrid, Spain) Type 2 diabetes and renal disease: impact on cardiovascular outcomes The "heavyweights" of modifiable CVD risk factors Hypertension
ALLHAT. 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,
BRFSS, , *BMI
The Epidemic of Obesity, Diabetes, and the Metabolic Syndrome Holly Novak, MD, FACC Obesity Trends* Among US Adults BRFSS, 1985 BRFSS=Behavioral Risk Factor Surveillance System. *Body Mass Index (BMI)
Strategies for Managing Hypertension
Strategies for Managing Hypertension by Marsha K. Millonig, MBA, RPh President,Catalyst Enterprises, LLC E.L.F. Publications, Inc. is accredited by the Accreditation Council for Pharmacy Education as a
Update 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
DISCLOSURE 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
HYPERTENSION 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
Update 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
ABCD and Renal Association Clinical Guidelines for Diabetic Nephropathy-CKD. Management of Dyslipidaemia and Hypertension in Adults Dr Peter Winocour
ABCD and Renal Association Clinical Guidelines for Diabetic Nephropathy-CKD. Management of Dyslipidaemia and Hypertension in Adults Dr Peter Winocour Dr Indranil Dasgupta Rationale No national practical
Macrovascular Residual Risk. What risk remains after LDL-C management and intensive therapy?
Macrovascular Residual Risk What risk remains after LDL-C management and intensive therapy? Defining Residual Vascular Risk The risk of macrovascular events and microvascular complications which persists
Managing Hypertension in Diabetes Sean Stewart, PharmD, BCPS, BCACP, CLS Internal Medicine Park Nicollet Clinic St Louis Park.
Managing Hypertension in Diabetes 2015 Sean Stewart, PharmD, BCPS, BCACP, CLS Internal Medicine Park Nicollet Clinic St Louis Park Case Scenario Mike M is a 59 year old man with type 2 diabetes managed
Hypertension Management in Diabetic Patients
Hypertension Management in Diabetic Patients Park, Chang G, MD, PhD Cardiovascular Center, Guro Hospital, Korea University Medical School Contents (Treatment of 2 Cases) Type 2 Diabetes Mellitus Hypertension
ΑΡΥΙΚΗ ΠΡΟΔΓΓΙΗ ΤΠΔΡΣΑΙΚΟΤ ΑΘΔΝΟΤ. Μ.Β.Παπαβαζιλείοσ Καρδιολόγος FESC - Γιεσθύνηρια ιζμανόγλειον ΓΝΑ Clinical Hypertension Specialist ESH
ΑΡΥΙΚΗ ΠΡΟΔΓΓΙΗ ΤΠΔΡΣΑΙΚΟΤ ΑΘΔΝΟΤ Μ.Β.Παπαβαζιλείοσ Καρδιολόγος FESC - Γιεσθύνηρια ιζμανόγλειον ΓΝΑ Clinical Hypertension Specialist ESH Hypertension Co-Morbidities HTN Commonly Clusters with Other Risk
Hypertension. 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
Prevention And Treatment of Diabetic Nephropathy. MOH Clinical Practice Guidelines 3/2006 Dr Stephen Chew Tec Huan
Prevention And Treatment of Diabetic Nephropathy MOH Clinical Practice Guidelines 3/2006 Dr Stephen Chew Tec Huan Prevention Tight glucose control reduces the development of diabetic nephropathy Progression
New 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
John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam
Latest Insights from the JUPITER Study John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Inflammation, hscrp, and Vascular Prevention
Environmental. Vascular / Tissue. Metabolics
Global Risk Reduction--WINS Picking Mom and Dad-2016 Environmental Vascular / Tissue Metabolics Stop smoking-1b Physical activity-1b Weight control-1b Chelation therapy-3c Influenza vaccination-1b Blood
Antihypertensive 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
Hypertension and Diabetes Will Controversies Help Our Patients? Insights of JNC Report Jorge De Jesús MD FACE
Hypertension and Diabetes Will Controversies Help Our Patients? Insights of JNC8 2013 Report Jorge De Jesús MD FACE Disclosures Dr Jorge De Jesús has received honorariums as speaker for the following pharmaceutical
egfr > 50 (n = 13,916)
Saxagliptin and Cardiovascular Risk in Patients with Type 2 Diabetes Mellitus and Moderate or Severe Renal Impairment: Observations from the SAVOR-TIMI 53 Trial Supplementary Table 1. Characteristics according
Diabetic Nephropathy. Objectives:
There are, in truth, no specialties in medicine, since to know fully many of the most important diseases a man must be familiar with their manifestations in many organs. William Osler 1894. Objectives:
Treating 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
Στόχοι αρτηριακής πίεσης σε ειδικούς πληθυσµούς και επιλογή φαρµάκων
Στόχοι αρτηριακής πίεσης σε ειδικούς πληθυσµούς και επιλογή φαρµάκων Εύα Καρπάνου Δ/ντρια Αντιυπερτασικού Ιατρείου Α ΚΚ Ωνάσειου ΚΚ Θεσσαλονίκη, 14/2/13 Η µελέτη δεν υποστηρίχθηκε από φαρµακευτικές εταιρείες
The Road to Renin System Optimization: Renin Inhibitor
The Road to Renin System Optimization: Renin Inhibitor A New Perspective on the Renin-Angiotensin System (RAS) Yong-Jin Kim, MD Seoul National University Hospital Human and Economic Costs of Hypertension
The target blood pressure in patients with diabetes is <130 mm Hg
Controversies in hypertension, About Diabetes diabetes and and metabolic Cardiovascular syndrome Risk ESC annual congress August 29, 2011 The target blood pressure in patients with diabetes is
Diabetes and Hypertension
Diabetes and Hypertension William C. Cushman, MD, FAHA, FACP, FASH Chief, Preventive Medicine, Veterans Affairs Medical Center Professor, Preventive Medicine, Medicine, and Physiology University of Tennessee
Hypertension 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
MANAGEMENT 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
Hypertension and the SPRINT Trial: Is Lower Better
Hypertension and the SPRINT Trial: Is Lower Better 8th Annual Orange County Symposium on Cardiovascular Disease Prevention Saturday, October 8, 2016 Keith C. Norris, MD, PhD, FASN Professor of Medicine,
Treatment to reduce cardiovascular risk: multifactorial management
Treatment to reduce cardiovascular risk: multifactorial management Matteo Anselmino, MD PhD Assistant Professor San Giovanni Battista Hospital Division of Cardiology, Department of Internal Medicine University
ALLHAT. 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
Hypertension 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,
New 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
Management 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
Hypertension 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
Role of Neurohormonal Antagonists in Management of Patients With Hypertension, Metabolic Syndrome, and Diabetes
Role of Neurohormonal Antagonists in Management of Patients With Hypertension, Metabolic Syndrome, and Diabetes Gregg C. Fonarow, MD Approximately 1.1 million individuals will have a new or recurrent myocardial
T. Suithichaiyakul Cardiomed Chula
T. Suithichaiyakul Cardiomed Chula The cardiovascular (CV) continuum: role of risk factors Endothelial Dysfunction Atherosclerosis and left ventricular hypertrophy Myocardial infarction & stroke Endothelial
Cardiovascular Management of a Patient with Diabetes
Cardiovascular Management of a Patient with Diabetes Dr Jeremy Krebs Clinical Leader Endocrinology and Diabetes Wellington Hospital Summary People with diabetes take a lot of medication Compliance and
Hypertension and obesity. Dr Wilson Sugut Moi teaching and referral hospital
Hypertension and obesity Dr Wilson Sugut Moi teaching and referral hospital No conflict of interests to declare Obesity Definition: excessive weight that may impair health BMI Categories Underweight BMI
Highlights of the new blood pressure and cholesterol guidelines: A whole new philosophy. Jeremy L. Johnson, PharmD, BCACP, CDE, BC-ADM
Highlights of the new blood pressure and cholesterol guidelines: A whole new philosophy Jeremy L. Johnson, PharmD, BCACP, CDE, BC-ADM OSHP 2014 Annual Meeting Oklahoma City, OK April 4, 2014 1 Objectives
The Metabolic Syndrome: Is It A Valid Concept? YES
The Metabolic Syndrome: Is It A Valid Concept? YES Congress on Diabetes and Cardiometabolic Health Boston, MA April 23, 2013 Edward S Horton, MD Joslin Diabetes Center Harvard Medical School Boston, MA
ADVANCES 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%
Is there a mechanism of interaction between hypertension and dyslipidaemia?
Is there a mechanism of interaction between hypertension and dyslipidaemia? Neil R Poulter International Centre for Circulatory Health NHLI, Imperial College London Daegu, Korea April 2005 Observational
APPENDIX 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
ADVANCES 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,
Secondary Prevention of Coronary Heart Disease
Secondary Prevention of Coronary Heart Disease Samornrat Jampates, MD. Cardiology department, CCIT 6 March 2014 Circulation. 2011;123:2274-2283. A B C D E S ABCDE + S Approach to Secondary CAD Prevention
Long-Term Complications of Diabetes Mellitus Macrovascular Complication
Long-Term Complications of Diabetes Mellitus Macrovascular Complication Sung Hee Choi MD, PhD Professor, Seoul National University College of Medicine, SNUBH, Bundang Hospital Diabetes = CVD equivalent
The Burden of the Diabetic Heart
The Burden of the Diabetic Heart Dr. Ghaida Kaddaha (MBBS, MRCP-UK, FRCP-london) Diabetes Unit Rashid Hospital Dubai U.A.E Risk of CVD in Diabetes Morbidity and mortality from CVD is 2-4 fold higher than
JNC 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
Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden
Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden Cardiovascular Disease Prevention (CVD) Three Strategies for CVD
Adult Diabetes Clinician Guide NOVEMBER 2017
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Adult Diabetes Clinician Guide Introduction NOVEMBER 2017 This evidence-based guideline summary is based on the 2017 KP National Diabetes Guideline.
Chronic Kidney Disease
Chronic Kidney Disease Chronic Kidney Disease (CKD) Educational Objectives Outline Demographics Propose Strategies to slow progression and improve outcomes Plan for treatment of CKD Chronic Kidney Disease
Hypertension in Clinical Practice. Abeer Al Saweer, MBBS, Arab Board*
1 Bahrain Medical Bulletin, Vol. 33, No. 1, March 2011 Education-Family Physician Corner Hypertension in Clinical Practice Abeer Al Saweer, MBBS, Arab Board* The global incidence of hypertension is growing.
Prevention of Cardiovascular Disease
Save Thais from Heart Diseases 2019 Prevention of Cardiovascular Disease Orawan Anupraiwan, MD. Central Chest Institute of Thailand ASCVD Prevention Pyramid Risk categories Very high-risk High-risk Documented
Diabetes and kidney disease.
Diabetes and kidney disease. What are the implications? Can it be prevented? Nice 18 june 2010 Lars G Weiss. M.D. Ph.D. Department of Neprology Central Hospital Karlstad Sweden Diabetic nephropathy vs
Diabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable?
Diabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable? Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of
7/7/ CHD/MI LVH and LV dysfunction Dysrrhythmias Stroke PVD Renal insufficiency and failure Retinopathy. Normal <120 Prehypertension
Prevalence of Hypertension Hypertension: Diagnosis and Management T. Villela, M.D. Program Director University of California, San Francisco-San Francisco General Hospital Family and Community Medicine
Index. Note: Page numbers of article titles are in boldface type.
Heart Failure Clin 2 (2006) 101 105 Index Note: Page numbers of article titles are in boldface type. A ACE inhibitors, in diabetic hypertension, 30 31 Adipokines, cardiovascular events related to, 6 Advanced
Hypertension with Comorbidities Treatment of Metabolic Risk Factors in Children and Adolescents
Hypertension with Comorbidities Treatment of Metabolic Risk Factors in Children and Adolescents Stella Stabouli Ass. Professor Pediatrics 1 st Department of Pediatrics Hippocratio Hospital Evaluation of
hypertension Head of prevention and control of CVD disease office Ministry of heath
hypertension t. Samavat MD,Cadiologist,MPH Head of prevention and control of CVD disease office Ministry of heath RECOMMENDATIONS FOR HYPERTENSION DIAGNOSIS, ASSESSMENT, AND TREATMENT Definition of hypertension
The New Hypertension Guidelines
The New Hypertension Guidelines Joseph Saseen, PharmD Professor and Vice Chair, Department of Clinical Pharmacy University of Colorado Anschutz Medical Campus Disclosure Joseph Saseen reports no conflicts
ALLHAT 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.
Cardiovascular Complications of Diabetes
VBWG Cardiovascular Complications of Diabetes Nicola Abate, M.D., F.N.L.A. Professor and Chief Division of Endocrinology and Metabolism The University of Texas Medical Branch Galveston, Texas Coronary
The Clinical Unmet need in the patient with Diabetes and ACS
The Clinical Unmet need in the patient with Diabetes and ACS Professor Kausik Ray (UK) BSc(hons), MBChB, MD, MPhil, FRCP (lon), FRCP (ed), FACC, FESC, FAHA Diabetes is a global public health challenge
CVD risk assessment using risk scores in primary and secondary prevention
CVD risk assessment using risk scores in primary and secondary prevention Raul D. Santos MD, PhD Heart Institute-InCor University of Sao Paulo Brazil Disclosure Honoraria for consulting and speaker activities
Randomized 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
VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION
VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION Dr Catherine BESEME Paris 6 th December 2005 6 th International Congress of Bangladesh Society of Medicine Hypertension is a risk factor at the source, with
The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009
The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009 Learning Objectives 1. Understand the role of statin therapy in the primary and secondary prevention of stroke 2. Explain
Managing Chronic Kidney Disease: Reducing Risk for CKD Progression
Managing Chronic Kidney Disease: Reducing Risk for CKD Progression Arasu Gopinath, MD Clinical Nephrologist, Medical Director, Jordan Landing Dialysis Center Objectives: Identify the most important risks
Dysglycaemia and Hypertension. Dr E M Manuthu Physician Kitale
Dysglycaemia and Hypertension Dr E M Manuthu Physician Kitale None Disclosures DM is MI equivalent MR FIT Objective was to assess predictors of CVD mortality among men with and without diabetes and
Hypertension is a major risk factor for
OPTIMAL RISK MANAGEMENT OF THE HYPERTENSIVE PATIENT WITH MULTIPLE RISK FACTORS * Keith C. Ferdinand, MD, FACC ABSTRACT To determine the risk of cardiovascular disease in patients with hypertension, it
VA/DoD Clinical Practice Guideline for the Diagnosis and Management of Hypertension - Pocket Guide Update 2004 Revision July 2005
VA/DoD Clinical Practice Guideline for the Diagnosis and Management of Hypertension - Pocket Guide Update 2004 Revision July 2005 1 Any adult in the health care system 2 Obtain blood pressure (BP) (Reliable,
Hypertension 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
Metformin should be considered in all patients with type 2 diabetes unless contra-indicated
November 2001 N P S National Prescribing Service Limited PPR fifteen Prescribing Practice Review PPR Managing type 2 diabetes For General Practice Key messages Metformin should be considered in all patients
A Fork in the Road: Navigating Through New Terrain
A Fork in the Road: Navigating Through New Terrain Carol Hatch Wysham, MD Clinical Associate Professor of Medicine University of Washington School of Medicine Section Head, Rockwood Center for Diabetes
Hypertension 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
Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology
Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology Disclosures In compliance with the accrediting board policies, the American Diabetes Association requires the
Jared 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
Metoprolol Succinate SelokenZOC
Metoprolol Succinate SelokenZOC Blood Pressure Control and Far Beyond Mohamed Abdel Ghany World Health Organization - Noncommunicable Diseases (NCD) Country Profiles, 2014. 1 Death Rates From Ischemic
4/4/17 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
JNC 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
Guest Speaker Evaluations Viewer Call-In Thanks to our Sponsors: Phone: Fax: Public Health Live T 2 B 2
Public Health Live T 2 B 2 Chronic Kidney Disease in Diabetes: Early Identification and Intervention Guest Speaker Joseph Vassalotti, MD, FASN Chief Medical Officer National Kidney Foundation Thanks to
Diabetes and Heart Disease. Sarah Alexander, MD, FACC Assistant Professor of Medicine Rush University Medical Center
Diabetes and Heart Disease Sarah Alexander, MD, FACC Assistant Professor of Medicine Rush University Medical Center No conflicts of interest or financial relationships to disclose. 2 What s the problem??