Hypertension with Comorbidities Treatment of Metabolic Risk Factors in Children and Adolescents
|
|
- Janice Carr
- 5 years ago
- Views:
Transcription
1 Hypertension with Comorbidities Treatment of Metabolic Risk Factors in Children and Adolescents Stella Stabouli Ass. Professor Pediatrics 1 st Department of Pediatrics Hippocratio Hospital
2 Evaluation of a child or adolescent with hypertension Etiology of Hypertension Target organ damage Cardiometabolic risk factors
3 The Case : A 14-year old Caucasian boy referred for BP levels for age, sex and height on more than 3 different occasions OBESITY WITH CENTRAL DISTRIBUTION Born preterm, BW: 2.4 Kg Weight at age of 1 year >90 th percentile Weight at age of 3 years > 95 th percentile, height> 90 th percentile OBESITY, PHYSCICAL INACTIVITY, HIGH SALT-FAT The patient reported 2-3 attempts to lose weight with diet with temporary results DIET His regular physical activity is limited to gymnastics classes-30 min sessions/1-2 times per week His regular diet includes daily consumption of soft drinks and salted snacks and many fast food meals His mother is also obese and has HTN and type 2 diabetes FAMILY HISTORY OF HTN and OBESITY GLUCOSE INTOLERANCE ELEVATED TRIGLYCERIDES, LOW HDL CHOLESTEROL
4 Metabolic risk factors and hypertension Hypertension Insulin resistance, glucose intolerance Diabetes Obesity Hgh TG Low HDL
5 Metabolic risk factors and hypertension Obesity Hypertension Hgh TG Low HDL Insulin resistance, glucose intolerance Diabetes Increased prevalence of TOD At risk of future CV morbidity and mortality
6 LVH prevalence (%) LVH and in children with HTN and metabolic risk factors LVMI<95th pc LVMI >95th pc HTN No of metabolic risk factors in addition to HTN Modified from Litwin et al, AJH 2007;20:
7 Prevalence of CVD risk factors among US adolescents, NHANES N = 3383 Ashleigh L. May et al. Pediatrics 2012;129:
8 Obesity and Nocturnal Blood Pressure Elevation in Children The role of insulin resistance Lurbe et al, Hypertension 2008;51:
9 Trends in High Blood Pressure among United States Adolescents across Body Weight Category between 1988 and 2012 Yang et al, J Pediatr Feb;169:166-73
10 Prehypertension and Cardiovascular Risk Factors in Children and Adolescents Participating in the Community-Based Prevention Education Program Family Heart Study Haas et al, Int J Prev Med Mar; 5(Suppl 1): S50 S56
11 Hypertension. 2014;63:
12 Management of HTN in children and adolescents with metabolic risk factors Goals: Reduce the risk of future cardiovascular events Delay or prevent the progression of TOD Target: BP Target : Metabolic risk factors
13 Lifestyle modification is the cornerstone of treatment Blood pressure Insulin resistance, diabetes Lifestyle modification Dyslipidemia Obesity
14 Effectiveness of Lifestyle Interventions in Child Obesity: Systematic Review With Meta-analysis Ho et al, Pediatrics 2012;130:e1647 e1671
15 A. Differences in mean diastolic blood pressure B. Differences in mean systolic blood pressure Effectiveness of Lifestyle Interventions in Child Obesity: Systematic Review With Meta-analysis Ho et al, Pediatrics 2012;130:e1647 e1671
16 Differences in mean fasting insulin and HOMA-IR Effectiveness of Lifestyle Interventions in Child Obesity: Systematic Review With Meta-analysis Ho et al, Pediatrics 2012;130:e1647 e1671
17 A. Mean differences in triglycerides concentrations B. Mean differences in LDL cholesterol C. Mean differences in HDL concentrations Effectiveness of Lifestyle Interventions in Child Obesity: Systematic Review With Meta-analysis Ho et al, Pediatrics 2012;130:e1647 e1671
18 2016 ESH guidelines for the management of high blood pressure in children and adolescents
19 BMI 2016 ESH guidelines for the management of high blood pressure in children and adolescents
20 Changes in BMI SDS, SBP and DBP SDS during weight loss in boys and girls Holm et al, Journal of Hypertension 2012, 30:
21 Holm et al, Journal of Hypertension 2012, 30: Changes in BMI SDS, SBP and DBP SDS during weight regain in boys and girls
22 Association of Parental Overweight and Cardiometabolic Diseases and Pediatric Adiposity and Lifestyle Factors with Cardiovascular Risk Factor Clustering in Adolescents Lee et al, Nutrients 2016, 8, 567
23 Physical activity 2016 ESH guidelines for the management of high blood pressure in children and adolescents
24 Exercise and BP control Physical activity reduces the risk for cardiovascular disease and prevents the development of HTN BP decreases and remains lower for the rest of 24h period after a 30min moderate exercise session The mechanisms involved in the BP lowering effect of physical activity are decreases in SNS, RAS activity, reduced production of inflammatory cytokines, improvement of insulin sensitivity and endothelial function Stabouli et al, Expert Rev. Cardiovasc. Ther. 2011;9(6):
25 Cardiorespiratory Fitness and Clustered Cardiovascular Disease Risk in U.S. Adolescents 1,247 youths aged years in the National Health and Nutrition Examination Surveys Lobelo et al, Journal of Adolescent Health 47 (2010)
26 Cardiorespiratory Fitness and Clustered Cardiovascular Disease Risk in U.S. Adolescents 1,247 youths aged years in the National Health and Nutrition Examination Surveys The association remained significant in both overweight and normal weight males and in normal weight females (p <.05) Lobelo et al, Journal of Adolescent Health 47 (2010)
27 Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program Intervention: Sixty-seven obese subjects (age 14.7 ±2.2 years) were randomly assigned to 6 months exercise(1 h, 3 times/week) or nonexercise protocol Improved endothelial function Significant reduction in cardiovascular risk factors BMI, BMI SD scores, waist/hip ratio, Ambulatory SBP, Fasting insulin, Insulin resistance, Triglycerides, LDL, Low-degree inflammation(crp, fibrinogen) Meyers et al, J Am Coll Cardiol. 2006;7;48(9):
28 Diet 2016 ESH guidelines for the management of high blood pressure in children and adolescents
29 He et al, Hypertension Nov;48(5):861-9.
30 He et al, Hypertension. 2008;51:
31 DASH diet The DASH diet emphasizes lower sodium consumption with plenty of fruits, vegetables, low-fat dairy, whole grains, and plant-based proteins The American Academy of Pediatrics has stated a DASH-style diet with sufficient protein and calories may also have potential health benefits for children Gidding SS, Dennison BA, Birch LL, et al. Dietary recommendations for children and adolescents: A guide for practitioners. Pediatrics. 2006;117(2):
32 Dietary Approaches to Stop Hypertension Diet, Weight Status, and Blood Pressure among Children and Adolescents: National Health and Nutrition Examination Surveys ,793 individuals aged 8 to 18 years Accordance with the DASH diet was low across the age groups DASH score was inversely associated with SBP among 14- to 18-year-olds a 1-point increase in DASH score was associated with a 0.46 mm Hg decrease in SBP No significant differences were seen among the other age categories, and there no significant differences seen with DBP, weight status, or waist circumference Cohen et al, J Acad Nutr Diet. 2017;117:
33 Change in DASH diet score and cardiovascular risk factors in youth with type 1 and type 2 diabetes mellitus: The SEARCH for Diabetes in Youth Study 797 participants in the SEARCH for Diabetes in Youth Study representing three time points: baseline, 12- and 60-month follow-up DASH-related adherence was poor and changed very little over time Increase in DASH diet score was significantly associated with: in HbA1c levels in youth with type 1 diabetes (β=-0.20, P=0.0063) in systolic blood pressure among youth with type 2 diabetes (β=-2.02, P=0.0406) Barnes et al, Nutrition & Diabetes (2013) 3, e91
34 The Efficacy of a Clinic-Based Behavioral Nutrition Intervention Emphasizing a DASH-Type Diet for Adolescents with Elevated BP Coucb et al, J Pediatr 2008;152:
35 When to initiate antihypertensive treatment?
36 When to initiate antihypertensive treatment? High-normal BP Hypertension Hypertensive Emergency/urgency One or more of the following conditions: Symptomatic Secondary Organ damage Diabetes NO Nonpharmacological treatment YES Pharmacological treatment 2016 ESH guidelines for the management of high blood pressure in children and adolescents
37 Choosing an antihypertensive agent HTN with metabolic risk factors Targeting on mechanisms of obesity-induced hypertension Drugs acting to SNS and RAS system or promote natriuresis Effect on obesity and related metabolic abnormalities Drugs affecting insulin resistance Changes in glucose levels Changes in lipid profile Redon J, et al., Scientific Council of the European Society of Hypertension. The metabolic syndrome in hypertension: European society of hypertension position statement. J Hypertens 2008; 26: Lurbe et al European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents J Hypertens ;34(10):
38 Impact of antihypertensive drugs on metabolic risk factors ACEIs and ARBs Inhibition of RAS may improve blood flow to muscles, decrease activity of SNS, improve insulin sensitivity May also have PPAR-γ effect on insulin sensitivity These agents are associated with lower risk of incidence of diabetes CCBs promote natriuresis and have vasolidating action β-blockers favor weight gain, adversely affect lipid and glucose metabolism and may increase the incidence of diabetes in patients with hyperinsulinemia Thiazide-like diuretics promote hypokaliemia, which worsens glucose intolerance Redon J, et al., Scientific Council of the European Society of Hypertension. The metabolic syndrome in hypertension: European society of hypertension position statement. J Hypertens 2008; 26:
39 BP goals- General hypertensive population children <16 years <95 th pc for age, sex and height pc (Recommended) <90 th pc (should be considered) (office BP, 24-h ABP, home BP) Diabetes type 1 and 2 adolescents 16 years <140/90 mmhg (Recommended) <90 th pc (Recommended) <75 th pc in non-proteinuric CKD (Recommended) <50 th pc in proteinuric CKD (Recommended) < 130/80 mmhg (Recommended) <125/75 mmhg in proteinuric CKD (Recommended) 2016 ESH guidelines for the management of high blood pressure in children and adolescents
40 Pharmacological treatment of metabolic risk factors?
41 Pharmacological treatment of metabolic risk factors in hypertensive children and adolescents? Uncertain state of knowledge on long-term safety of pharmacological therapy
42 The SEARCH for Diabetes in Youth Study Hamman et al, Diabetes Care 2014;37:
43 A Clinical Trial to Maintain Glycemic Control in Youth with Type 2 Diabetes 699 randomly assigned participants (mean duration of diagnosed type 2 diabetes, 7.8 months) over an average follow-up of 3.86 years N Engl J Med June 14; 366(24):
44 Management of metabolic risk factors Obesity gradual weight loss to reduce BMI<85 th pc lifestyle and behavioral modification for healthier dietary habits: Total fat 25-35% of calories, saturated fat<7% trans fat<1%, chilesterol<200mg/day, consume fruits, vegetables, fiber, reduce salt and sugar intake Physical inactivity <2h screen time/day, 60min moderate aerobic activity/day Glucose intolerance gradual weight loss to reduce BMI<85 th pc decrease calorie intake, physical activity Dyslipidemia Decrease low saturated and trans fat, physical activity Steinberg et al, Circulation. 2009;119: AHA Scientific statement. Progress and Challenges in Metabolic Syndrome in Children and Adolescents Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report. Pediatrics 2011;128;S213
45 Recommendations for pharmacological treatment may start at LDL-C >= 130 mg/dl if clustered CV risk factors If LDL >= 130 mg/dl and 2 high-level RF or 1 high-risk and 2 moderate level RF If LDL >= 160 mg/dl and 1 high-level RF or 2 moderate level RF If LDL >= 190 mg/dl Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report. Pediatrics 2011;128;S213
46 Conclusions The hypertensive child with metabolic risk factors represents a challenging case Lifestyle changes remain the cornerstone of the initial management as they appear to have significantly beneficial effect on both BP and metabolic abnormalities Close follow up is important and detection of TOD may emerge the need for early pharmacological therapy
47 Thank you for attention
Obesity and Hypertension. Manish Sinha Evelina London Children s Hospital
Obesity and Hypertension Manish Sinha Evelina London Children s Hospital Manchester 30 th June 2017 Scope of Talk Trends of childhood obesity in the UK Prevalence of hypertension in obese children Pathophysiology
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 informationVA/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,
More informationScreening Results. Juniata College. Juniata College. Screening Results. October 11, October 12, 2016
Juniata College Screening Results Juniata College Screening Results October 11, 2016 & October 12, 2016 JUNIATA COLLEGE The J.C. Blair Hospital CARES team screened 55 Juniata College employees on October
More informationClinical Recommendations: Patients with Periodontitis
The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease. Friedewald VE, Kornman KS, Beck JD, et al. J Periodontol 2009;
More informationObjectives. Objectives. Alejandro J. de la Torre, MD Cook Children s Hospital May 30, 2015
Alejandro J. de la Torre, MD Cook Children s Hospital May 30, 2015 Presentation downloaded from http://ce.unthsc.edu Objectives Understand that the obesity epidemic is also affecting children and adolescents
More informationAmerican Diabetes Association: Standards of Medical Care in Diabetes 2015
American Diabetes Association: Standards of Medical Care in Diabetes 2015 Synopsis of ADA standards relevant to the 11 th Scope of Work under Task B.2 ASSESSMENT OF GLYCEMIC CONTROL Recommendations: Perform
More informationUsing the New Hypertension Guidelines
Using the New Hypertension Guidelines Kamal Henderson, MD Department of Cardiology, Preventive Medicine, University of North Carolina School of Medicine Kotchen TA. Historical trends and milestones in
More informationEstablished Risk Factors for Coronary Heart Disease (CHD)
Getting Patients to Make Small Lifestyle Changes That Result in SIGNIFICANT Improvements in Health - Prevention of Diabetes and Obesity for Better Health Maureen E. Mays, MD, MS, FACC Director ~ Portland
More informationSession 21: Heart Health
Session 21: Heart Health Heart disease and stroke are the leading causes of death in the world for both men and women. People with pre-diabetes, diabetes, and/or the metabolic syndrome are at higher risk
More informationHypertension 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
More informationPrimary and Secondary Prevention of Cardiovascular Disease. Frank J. Green, M.D., F.A.C.C. St. Vincent Medical Group
Primary and Secondary Prevention of Cardiovascular Disease Frank J. Green, M.D., F.A.C.C. St. Vincent Medical Group AHA Diet and Lifestyle Recommendations Balance calorie intake and physical activity to
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 informationDiabetes and Hypertension
Diabetes and Hypertension M.Nakhjvani,M.D Tehran University of Medical Sciences 20-8-96 Hypertension Common DM comorbidity Prevalence depends on diabetes type, age, BMI, ethnicity Major risk factor for
More informationFructose, Uric Acid and Hypertension in Children and Adolescents
Fructose, Uric Acid and Hypertension in Children and Adolescents Daniel I. Feig, MD, PhD, MS Director, Division of Nephrology Department of Pediatrics University of Alabama, Birmingham Topics for Discussion
More informationmajor public health burden
HYPERTENSION INTRODUCTION Hypertension is one of the major public health burden in the recent times. Hypertension remains a challenging medical condition among the noncommunicable diseases of ever growing
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 informationCardiovascular 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
More informationTotal risk management of Cardiovascular diseases Nobuhiro Yamada
Nobuhiro Yamada The worldwide burden of cardiovascular diseases (WHO) To prevent cardiovascular diseases Beyond LDL Multiple risk factors With common molecular basis The Current Burden of CVD CVD is responsible
More informationCase Study #4: Hypertension and Cardiovascular Disease
Helen Jang Tara Hooley John K Rhee Case Study #4: Hypertension and Cardiovascular Disease 7. What risk factors does Mrs. Sanders currently have? The risk factors that Mrs. Sanders has are high blood pressure
More informationAdolescent Hypertension Roles of obesity and hyperuricemia. Daniel Landau, MD Pediatrics, Soroka University Medical Center
Adolescent Hypertension Roles of obesity and hyperuricemia Daniel Landau, MD Pediatrics, Soroka University Medical Center Blood Pressure Tables BP standards based on sex, age, and height provide a precise
More informationDr Doris M. W Kinuthia
Dr Doris M. W Kinuthia Objectives Normal blood pressures in children Measurement of blood pressure in children Aetiology of Hypertension in children Evaluation of children with hypertension Treatment of
More informationThe 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
More information2003 World Health Organization (WHO) / International Society of Hypertension (ISH) Statement on Management of Hypertension.
2003 World Health Organization (WHO) / International Society of Hypertension (ISH) Statement on Management of Hypertension Writing Group: Background Hypertension worldwide causes 7.1 million premature
More information7/6/2012. University Pharmacy 5254 Anthony Wayne Drive Detroit, MI (313)
University Pharmacy 5254 Anthony Wayne Drive Detroit, MI 48202 (313) 831-2008 Be able to identify the signs of a heart attack or stoke Identify what puts you at a higher risk for cardiovascular disease,
More informationSugar-Loaded Beverages and the Impact on Cardiovascular Health. Christina M. Shay, PhD, MA
Sugar-Loaded Beverages and the Impact on Cardiovascular Health Christina M. Shay, PhD, MA 1 Presenter Disclosure Information Christina M. Shay, PhD, MA Sugar-Loaded Beverages and the Impact on Cardiovascular
More informationHypertension Update. Sarah J. Payne, MS, PharmD, BCPS Assistant Professor, Department of Pharmacotherapy UNT System College of Pharmacy
Hypertension Update Sarah J. Payne, MS, PharmD, BCPS Assistant Professor, Department of Pharmacotherapy UNT System College of Pharmacy Introduction 1/3 of US adults have HTN More prevalent in non-hispanic
More informationHYPERTENSION: ARE WE GOING TOO LOW?
HYPERTENSION: ARE WE GOING TOO LOW? George L. Bakris, M.D.,F.A.S.N.,F.A.S.H., F.A.H.A. Professor of Medicine Director, ASH Comprehensive Hypertension Center University of Chicago Medicine Chicago, IL USA
More informationBlood Pressure Measurement (children> 3 yrs)
Blood Pressure Measurement (children> 3 yrs) If initial BP elevated, repeat BP manually 2x and average, then classify Normal BP Systolic and diastolic
More information2/11/2019 CLINICAL IMPLEMENTATION OF THE UPDATED BP GUIDELINES DUALITY OF INTEREST
CLINICAL IMPLEMENTATION OF THE UPDATED BP GUIDELINES George L. Bakris, M.D.,F.A.S.N., F.A.H.A. Professor of Medicine Director, Am Heart Assoc. Comprehensive Hypertension Center University of Chicago Medicine
More informationHEART HEALTH AND HEALTHY EATING HABITS
HEART HEALTH AND HEALTHY EATING HABITS ELIZABETH PASH PENNIMAN RD,LD CLINICAL DIETITIAN Professional Member American Heart Association; Council on Nutrition, Physical Activity and Metabolism PURPOSE: Recognize
More informationDiversity and HTN: Approaches to optimal BP control in AfricanAmericans
Diversity and HTN: Approaches to optimal BP control in AfricanAmericans Quinn Capers, IV, MD, FACC, FSCAI Assistant Professor of Medicine Associate Dean for Admissions Do Racial Differences Really Exist
More informationMacronutrients and Dietary Patterns for Glucose Control
제 20 회대한당뇨병학회춘계학술대회 Macronutrients and Dietary Patterns for Glucose Control 2017.5.13 서울대학교병원임정현 Conflict of interest disclosure None Committee of Scientific Affairs Contents Review of Nutrition Recommendation
More informationPage 1. Disclosures. Background. No disclosures
Population-Based Lipid Screening in the Era of a Childhood Obesity Epidemic: The Importance of Non-HDL Cholesterol Assessment Brian W. McCrindle, Cedric Manlhiot, Don Gibson, Nita Chahal, Helen Wong, Karen
More informationFructose in diabetes: Friend or Foe. Kim Chong Hwa MD,PhD Sejong general hospital, Division of Endocrinology & Metabolism
Fructose in diabetes: Friend or Foe Kim Chong Hwa MD,PhD Sejong general hospital, Division of Endocrinology & Metabolism Contents What is Fructose? Why is Fructose of Concern? Effects of Fructose on glycemic
More informationThe role of physical activity in the prevention and management of hypertension and obesity
The 1 st World Congress on Controversies in Obesity, Diabetes and Hypertension (CODHy) Berlin, October 26-29 2005 The role of physical activity in the prevention and management of hypertension and obesity
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 information«Πατσζαρκία και Καρδιαγγειακή Νόζος»
«Πατσζαρκία και Καρδιαγγειακή Νόζος» Δημήτρης Π. Παπαδόπουλος-FESC Clinical Assist. Professor George Washington University USA Επιμελητής Καρδιολογικής Κλινικής Π.Γ.Ν.Α. «ΛΑΪΚΟ» Υπεύθυνος Αντιυπερτασικού
More informationMetabolic Syndrome Across the Life Cycle - Adolescent. Joy Friedman MD
Metabolic Syndrome Across the Life Cycle - Adolescent Joy Friedman MD Disclosures I have no actual or potential conflict of interest in relation to this program or presentation. I will mention off-label
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 informationCardiovascular Disease Risk Factors:
Cardiovascular Disease Risk Factors: Risk factors are traits or habits that increase a person's chances of having cardiovascular disease. Some risk factors can be changed. These risk factors are high blood
More informationThe Metabolic Syndrome Update The Metabolic Syndrome Update. Global Cardiometabolic Risk
The Metabolic Syndrome Update 2018 Marc Cornier, M.D. Professor of Medicine Division of Endocrinology, Metabolism & Diabetes Anschutz Health and Wellness Center University of Colorado School of Medicine
More informationChapter 18. Diet and Health
Chapter 18 Diet and Health Risk Factors and Chronic Diseases Interrelationships among Chronic Diseases Chronic Disease Heart Disease and Stroke Hypertension Cancer Diabetes The Formation of Plaques in
More informationDiabetes 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
More informationCardiovascular disease, studies at the cellular and molecular level. Linda Lowe Krentz Bioscience in the 21 st Century September 23, 2009
Cardiovascular disease, studies at the cellular and molecular level Linda Lowe Krentz Bioscience in the 21 st Century September 23, 2009 Content Introduction The number 1 killer in America Some statistics
More informationDEPARTMENT OF GENERAL MEDICINE WELCOMES
DEPARTMENT OF GENERAL MEDICINE WELCOMES 1 Dr.Mohamed Omar Shariff, 2 nd Year Post Graduate, Department of General Medicine. DR.B.R.Ambedkar Medical College & Hospital. 2 INTRODUCTION Leading cause of global
More informationCARDIOVASCULAR RISK FACTORS & TARGET ORGAN DAMAGE IN GREEK HYPERTENSIVES
CARDIOVASCULAR RISK FACTORS & TARGET ORGAN DAMAGE IN GREEK HYPERTENSIVES C. Liakos, 1 G. Vyssoulis, 1 E. Karpanou, 2 S-M. Kyvelou, 1 V. Tzamou, 1 A. Michaelides, 1 A. Triantafyllou, 1 P. Spanos, 1 C. Stefanadis
More informationProject Summary: Draft Proposal Continued RESULTS. on the DASH Diet and 30 of the 40 original subjects on the Pro-DASH Diet.
Project Summary: Draft Proposal Continued RESULTS Subjects The HNFE 3034 Spring 2013 semester s research study included 34 of the 38 original subjects on the DASH Diet and 30 of the 40 original subjects
More informationResults/ conclusion. Reference Duration Number subjects. Study description. Limitations of the data. Randomized controlled trial (RCT)
(original) Appel, 1997 8 weeks 459 459 ; all received a control SAD for 3 weeks then randomized to (i) control (ii) a diet rich in fruits and veg (FV) or (iii) a combination diet (combo) rich in fruits,
More informationImplications of The LookAHEAD Trial: Is Weight Loss Beneficial for Patients with Diabetes?
Implications of The LookAHEAD Trial: Is Weight Loss Beneficial for Patients with Diabetes? Boston, MA November 7, 213 Edward S. Horton, MD Professor of Medicine Harvard Medical School Senior Investigator
More informationNutrition and Medicine, 2006 Tufts University School of Medicine Nutrition and Type 2 Diabetes: Learning Objectives
Nutrition and Medicine, 2006 Tufts University School of Medicine Nutrition and Type 2 Diabetes: Learning Objectives Margo N. Woods, D.Sc. 1. Discuss the increase in the incidence and prevalence of type
More informationHealth Score SM Member Guide
Health Score SM Member Guide Health Score Your Health Score is a unique, scientifically based assessment of seven critical health indicators gathered during your health screening. This number is where
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 informationKnow Your Number Aggregate Report Comparison Analysis Between Baseline & Follow-up
Know Your Number Aggregate Report Comparison Analysis Between Baseline & Follow-up... Study Population: 340... Total Population: 500... Time Window of Baseline: 09/01/13 to 12/20/13... Time Window of Follow-up:
More informationNutritional Recommendations for the Diabetes Managements
In the name of God Nutritional for the Diabetes Managements Zohreh Mazloom. PhD Shiraz University of Medical Sciences School of Nutrition and Food Sciences Department of Clinical Nutrition OVERVIEW Healthful
More informationLooking Toward State Health Assessment.
CONNECTICUT DEPARTMENT OF PUBLIC HEALTH Policy, Planning and Analysis. Looking Toward 2000 - State Health Assessment. Table of Contents Glossary Maps Appendices Publications Public Health Code PP&A Main
More informationYour Name & Phone Number Here! Longevity Index
Your Name & Phone Number Here! Longevity Index Your Health Risk Analysis is based on a variety of medical and scientific data from organizations such as the American Heart Association, American Dietetic
More informationTraditional Asian Soyfoods. Proven and Proposed Cardiovascular Benefits of Soyfoods. Reduction (%) in CHD Mortality in Eastern Finland ( )
Proven and Proposed Cardiovascular Benefits of Soyfoods Mark Messina, PhD, MS Soy Nutrition Institute Loma Linda University Nutrition Matters, Inc. markjohnmessina@gmail.com 1000 80 20 60 40 40 60 20 80
More informationDefinition High Blood Pressure is a
May 10th 2014 Definition High Blood Pressure is a common condition in which the force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.
More informationEvolving Concepts on Hypertension: Implications of Three Guidelines (JNC 8 Panel, ESH/ESC, NICE/BSH)
Evolving Concepts on Hypertension: Implications of Three Guidelines (JNC 8 Panel, ESH/ESC, NICE/BSH) Sidney C. Smith, Jr. MD, FACC, FAHA, FESC Professor of Medicine/Cardiology University of North Carolina
More informationDiabetes: Use of Adjunctive Therapy ACEs, ARBs, ASA & STATINs --Oh My! Veronica J. Brady, PhD, FNP-BC, BC-ADM, CDE Project ECHO April 19, 2018
Diabetes: Use of Adjunctive Therapy ACEs, ARBs, ASA & STATINs --Oh My! Veronica J. Brady, PhD, FNP-BC, BC-ADM, CDE Project ECHO April 19, 2018 Points to Ponder ASCVD is the leading cause of morbidity
More informationUpdate on Current Trends in Hypertension Management
Friday General Session Update on Current Trends in Hypertension Management Shawna Nesbitt, MD Associate Dean, Minority Student Affairs Associate Professor, Department of Internal Medicine Office of Student
More informationStroke: Prevention is the Best Medicine
Stroke: Prevention is the Best Medicine Donna Lindsay, MN, RN, CNS-BC, SCRN Neuroscience Clinical Nurse Specialist/ Stroke Program Coordinator Hennepin Stroke Center Stroke Statistics Approximately 795,000
More informationNutrition Care Process. Catherine Villafranca & Anthony Richitt
Nutrition Care Process Catherine Villafranca & Anthony Richitt Nutrition Care Process -According to eatrightpro.org, the Nutrition Care Process is a systematic approach to providing high-quality nutrition
More informationASSeSSing the risk of fatal cardiovascular disease
ASSeSSing the risk of fatal cardiovascular disease «Systematic Cerebrovascular and coronary Risk Evaluation» think total vascular risk Assess the risk Set the targets Act to get to goal revised; aupril
More informationCardiometabolic Side Effects of Risperidone in Children with Autism
Cardiometabolic Side Effects of Risperidone in Children with Autism Susan J. Boorin, MSN, PMHNP-BC PhD Candidate Yale School of Nursing 1 This speaker has no conflicts of interest to disclose. 2 Boorin
More informationCardiovascular disease physiology. Linda Lowe-Krentz Bioscience in the 21 st Century November 2, 2016
Cardiovascular disease physiology Linda Lowe-Krentz Bioscience in the 21 st Century November 2, 2016 Content Introduction The number 1 killer in America Some statistics Recommendations The disease process
More informationBuilding Our Evidence Base
Plant-Based Diets Neal D. Barnard, MD, FACC Adjunct Associate Professor of Medicine George Washington University School of Medicine Physicians Committee for Responsible Medicine Washington, DC Building
More informationKnow Your Number Aggregate Report Single Analysis Compared to National Averages
Know Your Number Aggregate Report Single Analysis Compared to National s Client: Study Population: 2242 Population: 3,000 Date Range: 04/20/07-08/08/07 Version of Report: V6.2 Page 2 Study Population Demographics
More informationHypertensionTreatment Guidelines. Michaelene Urban APRN, MSN, ACNS-BC, ANP-BC
HypertensionTreatment Guidelines Michaelene Urban APRN, MSN, ACNS-BC, ANP-BC Objectives: Review the definition of the different stages of HTN. Review the current guidelines for treatment of HTN. Provided
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 informationHypertension. Risk of cardiovascular disease beginning at 115/75 mmhg doubles with every 20/10mm Hg increase. (Grade B)
Practice Guidelines and Principles: Guidelines and principles are intended to be flexible. They serve as reference points or recommendations, not rigid criteria. Guidelines and principles should be followed
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 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 informationMedical Nutrition Therapy Options for Adults Living with Diabetes. Jane Eyre Schuster, RD, LD, CDE Legacy Health Diabetes and Nutrition Services
Medical Nutrition Therapy Options for Adults Living with Diabetes Jane Eyre Schuster, RD, LD, CDE Legacy Health Diabetes and Nutrition Services Objectives Discuss Medical Nutrition Therapy considerations
More informationΑΡΥΙΚΗ 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
More informationRisk Factors for Heart Disease
Risk Factors for Heart Disease Risk Factors we cannot change (Age, Gender, Family History) Risk Factors we can change (modifiable) Smoking Blood pressure Cholesterol Diabetes Inactivity Overweight Stress
More informationFor instance, it can harden the arteries, decreasing the flow of blood and oxygen to the heart. This reduced flow can cause
High Blood Pressure Blood pressure is the force of blood against your artery walls as it circulates through your body. Blood pressure normally rises and falls throughout the day, but it can cause health
More informationDepok-Indonesia STEPS Survey 2003
The STEPS survey of chronic disease risk factors in Indonesia/Depok was carried out from February 2003 to March 2003. Indonesia/Depok carried out Step 1, Step 2 and Step 3. Socio demographic and behavioural
More informationConflict of Interest Disclosure. Learning Objectives. Learning Objectives. Guidelines. Update on Lifestyle Guidelines
Conflict of Interest Disclosure Updates for the Ambulatory Care Pharmacist: Dyslipidemia and CV Risk Assessment No conflicts of interest to disclose 2014 Updates to the Updates in Ambulatory Care Pharmacy
More informationManaging High Blood Pressure Naturally. Michael A. Smith, MD Life Extension s Healthy Talk Series
Managing High Blood Pressure Naturally Michael A. Smith, MD Life Extension s Healthy Talk Series Part 1 What is Blood Pressure? Blood Pressure Systole Systolic Forward Pressure 110 mmhg 70 mmhg Diastole
More informationThe 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
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 informationMPharmProgramme. Hypertension (HTN)
MPharmProgramme Hypertension (HTN) Slide 1 of 30 Overview Definition Prevalence Type Causes Diagnosis Management Patients perspective Slide 2 of 30 Definition It is not a disease! So what is it? What two
More informationClinical Study Assessment of Metformin as an Additional Treatment to Therapeutic Lifestyle Changes in Pediatric Patients with Metabolic Syndrome
Cholesterol Volume 2012, Article ID 961410, 5 pages doi:10.1155/2012/961410 Clinical Study Assessment of Metformin as an Additional Treatment to Therapeutic Lifestyle Changes in Pediatric Patients with
More informationDisorders of Lipid Metabolism Toolkit Table of Contents
American Dietetic Association Table of Contents 1. Acknowledgements 2. Overview of 3. Medical Nutrition Therapy Protocol Forms for Implementing Disorders of Lipid Metabolism Evidence-Based Guideline a.
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 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 informationObesity and the Metabolic Syndrome in Developing Countries: Focus on South Asians
Obesity and the Metabolic Syndrome in Developing Countries: Focus on South Asians Anoop Misra Developing countries, particularly South Asian countries, are witnessing a rapid increase in type 2 diabetes
More information1/14/2013 Pediatric Cardiovascular Disease and the Future of our Children Linda Alwine FNP-BC Objectives Identify the prevalence and epidemiology of h
Pediatric Cardiovascular Disease and the Future of our Children Linda Alwine FNP-BC Objectives Identify the prevalence and epidemiology of hyperlipidemia. Identify risk factors that lead to the development
More informationDisclosures. Obesity and Its Challenges: Outline. Outline 5/2/2013. Lan Vu, MD Division of Pediatric Surgery Department of Surgery
Obesity and Its Challenges: Bariatric Surgery: Why or Why Not I have nothing to disclose Disclosures Lan Vu, MD Division of Pediatric Surgery Department of Surgery Outline Growing obesity epidemic Not
More informationHypertension, Hyperlipidemia and Obesity. Mi-CCSI
Hypertension, Hyperlipidemia and Obesity Mi-CCSI Objectives Review the prevalence of hypertension, hyperlipidemia and obesity Correlation of the 3 conditions Discuss why it is important to treat these
More informationNutrition and Heart Disease. by Rachel Kay, MS, RDN, CD Clinical Nutrition Specialist at Swedish Medical Center
Nutrition and Heart Disease by Rachel Kay, MS, RDN, CD Clinical Nutrition Specialist at Swedish Medical Center Objectives 1. Be able to identify recommended diet changes for patients with cardiovascular
More informationSTATE OF THE STATE: TYPE II DIABETES
STATE OF THE STATE: TYPE II DIABETES HENRY DRISCOLL, MD, CHIEF of ENDOCRINOLOGY MARSHALL U, CHERTOW DIABETES CENTER, HUNTINGTON VAMC HEATHER VENOY, RD, LD, CDE DIETITIAN, DIABETES EDUCATOR, CHERTOW DIABETES
More informationLong-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
More informationMetabolic Syndrome.
www.bmiweightloss.com.au What is the metabolic syndrome? The was first described in 1988 by Gerald Reavson It was originally described as the clustering of four conditions These conditions when present
More informationHow Low Do We Go? Update on Hypertension
How Low Do We Go? Update on Beth L. Abramson, MD, FRCPC, FACC As presented at the University of Toronto s Saturday at the University Session (September 2003) Arecent World Health Organization report states
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 informationHTN talk_l Davis_ /28/2018
1 2 GUIDELINES PUBLISHED AHEAD OF PRINT NOV 13, 2017 = SAME DAY AS PUBLIC PRESENTATION LESLIE L DAVIS, PHD, RN, ANP-BC, FPCNA, FAANP, FAHA The New Guidelines Have Been Published! Whelton PK, Carey RM,
More informationHypertension: JNC-7. Southern California University of Health Sciences Physician Assistant Program
Hypertension: JNC-7 Southern California University of Health Sciences Physician Assistant Program Management and Treatment of Hypertension April 17, 2018, presented by Ezra Levy, Pharm.D.! Reference Card
More information