Objectives. JNC 7 Is Nice But What s Up With JNC 8? Why Do We Care? Hypertension Background: Prevalence

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Objectives. JNC 7 Is Nice But What s Up With JNC 8? Why Do We Care? Hypertension Background: Prevalence"

Transcription

1 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 Assistant Program Keck School of Medicine of USC Objectives Overview of Hypertension Review of JNC 7 Guidelines Gain insight into the process for the next HTN practice guidelines Brief overview of the data contributing to the new guideline development A stab at what JNC 8 (?) might say Hypertension Background: Prevalence ~65 million American adults (1 in 3) have HTN Very common and often severe in African Americans Middle-aged Americans: 90% chance of developing HTN Why Do We Care? Increasing blood pressure linearly correlates with increasing cardiovascular mortality, morbidity and all cause mortality More than 75 percent of patients with Heart Failure have antecedent Hypertension Number one cause of Chronic Kidney Disease is Hypertension Hypertension 2004;44:1 7 1

2 Women and Hypertension Age Adjusted CV Disease Mortality Rate by SBP and DBP Level Used to Define Each JNC VI Stratum JAMA. 2002;287:2615 Defining Hypertension: History of the JNC Guidelines JNC 1; 1976 no specific recommendation on treating SBP; Identified DHTN at 105; consider treatment JNC 2; 1980 no specific recommendation on treating SBP; Identified DHTN as mild;90-105, moderate; , severe; >115 JNC 3; 1984 identified SBP as borderline; DBP normal; <85, high normal; 85-90, DHTN, as mild;90-105, moderate; , severe; >115 JNC 4; 1988 identified SBP < 140 as normal, as borderline; DBP normal; <85, high normal; 85-90, DHTN, as mild;90-105, moderate; , severe; >115 JNC 5; 1992 SBP <110; optimal, ; normal, ; High Normal, SHTN ; Stage1, ; Stage 2, ; Stage 3, >210; Stage 4. DBP, 80-85; normal, 85-90; high normal, ; Stage 1, ; Stage 2, ; Stage 3, >120; Stage 4 JNC 6; 1997 Essentially unchanged, deletes Stage 4 concept for both systolic and diastolic HTN Criteria (JNC 7) Normal less than 120/80 Pre hypertension /80 89 Stage /90 99 Stage 2 greater than 160/100 JNC 7; 2003 JNC 8?? 2

3 Hypertension Background: Risk factors Obesity Diabetes Type 2 Hyperlipidemia Alcohol Smoking Black race Salt intake Hostile/impatient personality Family history of HTN Prehypertension Causes of Hypertension Essential (primary) hypertension (>90%) [maybe not so essential] Renal insufficiency (parenchymal disease) Renal artery stenosis (fibromuscular dysplasia or atherosclerosis) Primary hyperaldosteronism Pheochromocytoma Cushing's disease/syndrome Coarctation of the aorta Thyroid disorders Sleep apnea Alcohol (excessive) Obesity (contributing factor) Medications that may increase blood pressure: Estrogen (oral contraceptives) Glucocorticoids Nonsteroidal anti inflammatory drugs (NSAIDs) Sympathomimetics Cyclosporine Most Patients With Hypertension Have Other Risk Factors for CVD Hypertension: More of the Usual Suspects 26 % 18% BP BP % % 21% 40% of persons with hypertension have impaired glucose tolerance the direct relationship between hyperinsulinemia and hypertension has not been proven but; insulin stimulates the sympathetic nervous system vascular endothelial inflammation and damage Other sources of risk = TC, HDL-C, TG, BMI, Glucose Kannel WB. Am J Hypertens. 2000;13:3s-10s. 3

4 Metabolic Syndrome: Hypertension JNC 7; Recommendations How can hyperinsulinemia increase blood pressure? renal Na + /water reabsorption SNS activity NA + K + ATPase activity Na + H + exchanger growth factors Number of Different BP Meds Needed to Reach Target BP Levels Increasing Dose vs. Combination AJHP 2006; 63:

5 What about JNC 8? JNC LATE JNC WAIT Probably will be called JNC 2013 It s tough to make predictions, especially about the future Yogi Berra Heartwire; November 24, 2011 Dr. Suzanne Oparil: it s a different process The Expert Committee has taken its literature review back to 1966 moving forward, the guidelines will be continually updated. Guidelines will only be based on RCTs. Boring But Important! Understanding the genesis of the recommendations will help foster acceptance in clinical practice 5

6 Ranking the Evidence Ranking Recommendations Guidelines-Current State of Affairs: Scientific Evidence Underlying the ACC/AHA Clinical Practice Guidelines Among ACC/AHA guidelines updated by Sept % increase (1330 to 1973) in # of recommendations most are based on Class II (conflicting evidence) Of 16 current guidelines with level of evidence recommendations 12% (314/2711) are Level A (multiple RCTs) 46% (1246/2711) are Level C (expert opinion,... no RCTs) Only 9% (245/2711) are Class I and Level A Increased Resources($) are needed to fund trials supporting guideline development Tricoci, et al. JAMA. 2009; 301: To be trustworthy, clinical practice guidelines should: Be based on a systematic review of the existing evidence Be developed by a knowledgeable, multidisciplinary panel of experts and representatives from key affected groups Consider important patient subgroups and patient preferences, as appropriate Be based on an explicit and transparent process that minimizes distortions, biases, and conflicts of interest Provide a clear explanation of the logical relationships between alternative care options and health outcomes, and provide ratings of both the quality of evidence and the strength of recommendations Be reconsidered and revised as appropriate when important new evidence warrants modifications of recommendations. 6

7 Critical Questions Being Addressed Among adults, does treatment with antihypertensive pharmacological therapy to a specific BP goal lead to improvements in health outcomes? (how low should you go) n=56 RCTs Among adults with hypertension, does initiating antihypertensive pharmacological therapy at specific BP thresholds improve health outcomes? (when to initiate drug treatment) n=26 RCTs In adults with hypertension, do various antihypertensive drugs or drug classes differ in comparative benefits and harms on specific health outcomes? (How do we get there?) n=66 RCTs How Low Should We Go? JNC 7; 140/90 (130/85 for DM/CKD) HOT trial; no difference between 80/90 DBP (except maybe some CVD reduction in DM2) AASK trial; no difference between 125/75 and 140/90 (except maybe if proteinuria >300) ACCORD trial; no difference for SBP < 135 ABCD trial; no benefit for intensive SBP lowering (132 v. 138 achieved) SHEP, SYS EURO, HOT, UKPDS trials showed 30 69% risk reduction by reducing SBP to about 140 When Do We Initiate Drug Treatment? Most would agree that we use lifestyle changes first unless blood pressure is more than 20mmHg over target JNC 7; 140/90 (130/85 for DM/CKD) HOT trial; no difference between 80/90 DBP (except maybe some CVD reduction in DM2) AASK trial; no difference between 125/75 and 140/90 (except maybe if proteinuria >300) ACCORD trial; no difference for SBP < 135 ABCD trial; no benefit for intensive SBP lowering (132 v. 138 achieved) SHEP, SYS EURO, HOT, UKPDS trials showed 30 69% risk reduction by reducing SBP to about 140 How Do We Get There? ALLHAT; chlorthalidone vs. amlodipine v. lisinopril: no significant difference ONTARGET; telmisartan vs. ramipril vs combo: no significant difference alone no benefit from combo MRFIT; chlorthalidone vs. HCTZ: chlorthalidone better especially at night ACCOMPLISH; amlodipine + HCTZ vs. amlodipine + benazepril: Amlodipine + benazepril better (note: not chlorthalidone) 7

8 NICE Hypertension Guidelines 2011 Key points It doesn t matter what you use Doing something is better (cheaper) than doing nothing Ambulatory blood pressure monitoring preferable Beta blocker least cost effective Guidelines: <55 >55 or Black Race Step 1: ACE/ARB CCB Step 2: ACE/ARB + CCB STEP 3: ACE/ARB + chlorthalidone + CCB Step 4: add spironolactone and consider consultation STITCH Simplified Therapeutic Intervention to Control HTN Trial Canadian Heath System, 2048 patients 3 groups; usual care vs. standard guidelines vs. STITCH intervention Guidelines similar to JNC 6 At 6 months 67% vs. 53% at goal compared to usual care or standard guidelines Guidelines Step 1 ½ tab of ACE or ARB/Thiazide Diuretic combination Step 2 increase to full tablet Step 3 add CCB Step 4 add alpha blocker or beta blocker or spironolactone What About JNC 13? Its always wise to look ahead but difficult to look further than you can see Winston Churchill JNC 2013?? The BP target for most will be <140/90 mmhg BP for those age >60, <150/90 mmhg Combinations of RAS blockers with thiazide diuretics or RAS blockers and dihydropyridine CCBs are acceptable first line combos to get BP to goal, if >20/10 mmhg above goal Chlorthalidone preferable to HCTZ Beta Blocker only if compelling indication Spironolactone for resistant HTN ACEi + ARB not recommended 8

9 My Thoughts Consider ambulatory BP monitoring Don t hesitate to ask for the evidence!! Lifestyle changes are dramatically effective Resist temptation of therapeutic inertia JUST TREAT IT!!! 9

DISCLOSURE PHARMACIST OBJECTIVES 9/30/2014 JNC 8: A REVIEW OF THE LONG-AWAITED/MUCH-ANTICIPATED HYPERTENSION GUIDELINES. I have nothing to disclose.

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

More information

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 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 information

Objectives. Describe results and implications of recent landmark hypertension trials

Objectives. 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 information

Jared Moore, MD, FACP

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

More information

Hypertension Update Warwick Jaffe Interventional Cardiologist Ascot Hospital

Hypertension 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 information

The Latest Generation of Clinical

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

More information

Combination Therapy for Hypertension

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

More information

Treating Hypertension in Individuals with Diabetes

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

More information

None. Disclosure: Relationships with Industry Conflicts of Interests. Learning Objectives: Participants will be able to:

None. Disclosure: Relationships with Industry Conflicts of Interests. Learning Objectives: Participants will be able to: 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) James W. Shaw, MD Memorial Lecture

More information

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, 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 information

Hypertension 2015: Recent Evidence that Will Change Your Practice

Hypertension 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 information

HYPERTENSION GUIDELINES WHERE ARE WE IN 2014

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

More information

Hypertension Update Background

Hypertension Update Background Hypertension Update Background Overview Aaron J. Friedberg, MD Assistant Professor, Clinical Division of General Internal Medicine The Ohio State University Wexner Medical Center Management Guideline Comparison

More information

Difficult-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 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 information

Management of Hypertension. M Misra MD MRCP (UK) Division of Nephrology University of Missouri School of Medicine

Management of Hypertension. M Misra MD MRCP (UK) Division of Nephrology University of Missouri School of Medicine Management of Hypertension M Misra MD MRCP (UK) Division of Nephrology University of Missouri School of Medicine Disturbing Trends in Hypertension HTN awareness, treatment and control rates are decreasing

More information

Hypertension Update. Aaron J. Friedberg, MD

Hypertension Update. Aaron J. Friedberg, MD Hypertension Update Aaron J. Friedberg, MD Assistant Professor, Clinical Division of General Internal Medicine The Ohio State University Wexner Medical Center Background Diagnosis Management Overview Guideline

More information

Management of High Blood Pressure in Adults

Management 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 information

JNC-8. (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure- 8) An Update on Hypertension Guidelines

JNC-8. (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure- 8) An Update on Hypertension Guidelines JNC-8 (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure- 8) An Update on Hypertension Guidelines Derrick Sorweide, DO Assistant Professor of Family Medicine,

More information

JNC 8 -Controversies. Sagren Naidoo Nephrologist CMJAH

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

More information

We are delighted to have Dr. Roetzheim with us today to discuss Managing Hypertension in Older Adult Patients.

We 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 information

JNC Evidence-Based Guidelines for the Management of High Blood Pressure in Adults

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

More information

ADVANCES IN MANAGEMENT OF HYPERTENSION

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%

More information

Hypertension Update Clinical Controversies Regarding Age and Race

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

More information

Hypertension Management: A Moving Target

Hypertension 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 information

Diabetes and Hypertension

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

More information

What s In the New Hypertension Guidelines?

What 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 information

Preventing and Treating High Blood Pressure

Preventing 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 information

Hypertension 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 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 information

Updates in Cardiovascular Recommendations for Diabetic Patients

Updates in Cardiovascular Recommendations for Diabetic Patients Updates in Cardiovascular Recommendations for Diabetic Patients Chris Tawwater, Pharm.D., BCPS Clinical Pharmacist, Abilene Regional Medical Center Assistant Professor, Adult Medicine Division Pharmacotherapy

More information

Modern Management of Hypertension

Modern 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 information

2014 HYPERTENSION GUIDELINES

2014 HYPERTENSION GUIDELINES 2014 HYPERTENSION GUIDELINES Eileen M. Twomey, Pharm.D., BCPS 1 Learning Objectives Describe specific blood pressure thresholds at which antihypertensive therapy should be initiated and blood pressure

More information

MANAGEMENT OF HYPERTENSION: TREATMENT THRESHOLDS AND MEDICATION SELECTION

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

More information

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 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 information

T. Suithichaiyakul Cardiomed Chula

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

More information

RESISTANT HYPERTENSION

RESISTANT HYPERTENSION RESISTANT HYPERTENSION John D. Bisognano, MD PhD Professor of Medicine / Cardiology President-Elect, American Society of Hypertension Director, Outpatient Cardiology University of Rochester RESISTANT HYPERTENSION

More information

Update in Hypertension

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

More information

DISCLOSURES OUTLINE OUTLINE 9/29/2014 ANTI-HYPERTENSIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE

DISCLOSURES 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 information

Hypertension Management Controversies in the Elderly Patient

Hypertension 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

ADVANCES IN MANAGEMENT OF HYPERTENSION

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,

More information

Treating Hypertension from

Treating Hypertension from Treating Hypertension from Initiation to Resistance: A Case Study Approach Michelle Krause, MD Division of Nephrology University of Arkansas for Medical Sciences Central Arkansas Veteran s Healthcare System

More information

Management of Lipid Disorders and Hypertension: Implications of the New Guidelines

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

More information

Prevention of Heart Failure: What s New with Hypertension

Prevention of Heart Failure: What s New with Hypertension Prevention of Heart Failure: What s New with Hypertension Ali AlMasood Prince Sultan Cardiac Center Riyadh 3ed Saudi Heart Failure conference, Jeddah, 13 December 2014 Background 20-30% of Saudi adults

More information

MODERN 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. 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 information

Modern Management of Hypertension

Modern Management of Hypertension 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 information

Hypertension in the Era of ACC/AHA: Practice Changing Evidence and Recommendations

Hypertension in the Era of ACC/AHA: Practice Changing Evidence and Recommendations Hypertension in the Era of ACC/AHA: Practice Changing Evidence and Recommendations Gerald W. Smetana, M.D., MACP Division of General Medicine Beth Israel Deaconess Medical Center Professor of Medicine

More information

Hypertension Pharmacotherapy: A Practical Approach

Hypertension Pharmacotherapy: A Practical Approach Hypertension Pharmacotherapy: A Practical Approach Ronald Victor, MD Burns & Allen Chair in Cardiology Director, The Hypertension Center Associate Director, The Heart Institute Hypertension Center 1. 2.

More information

Managing Hypertension in 2016

Managing 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 information

Modern Management of Hypertension

Modern 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 Blood Pressure and Risk Risk of Cardiovascular

More information

Diagnosis and treatment of hypertension. Kari Nelson, MD MSHS Division of General Internal Medicine VA Puget Sound, University of Washington

Diagnosis and treatment of hypertension. Kari Nelson, MD MSHS Division of General Internal Medicine VA Puget Sound, University of Washington Diagnosis and treatment of hypertension Kari Nelson, MD MSHS Division of General Internal Medicine VA Puget Sound, University of Washington Outline Epidemiology Diagnosis Evaluation of individuals with

More information

RESISTENT HYPERTENSION. Dr. Helmy Bakr Professor and Head of Cardiology Dept. Mansoura University

RESISTENT HYPERTENSION. Dr. Helmy Bakr Professor and Head of Cardiology Dept. Mansoura University RESISTENT HYPERTENSION Dr. Helmy Bakr Professor and Head of Cardiology Dept. Mansoura University Resistant Hypertension Blood pressure remaining above goal in spite of concurrent use of 3 antihypertensive

More information

Hypertension JNC 8 (2014)

Hypertension 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 information

Managing Hypertension in Diabetes Sean Stewart, PharmD, BCPS, BCACP, CLS Internal Medicine Park Nicollet Clinic St Louis Park.

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

More information

DEPARTMENT OF GENERAL MEDICINE WELCOMES

DEPARTMENT 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 information

Hypertension Update. Objectives 4/28/2015. Beverly J. Mathis, D.O. OOA May 2015

Hypertension Update. Objectives 4/28/2015. Beverly J. Mathis, D.O. OOA May 2015 Hypertension Update Beverly J. Mathis, D.O. OOA May 2015 Objectives Learn new recommendations for BP treatment goals Approach to hypertension in the office Use of hypertensive drugs, and how to tailor

More information

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 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 information

Hypertension: What s new since JNC 7. Harold M. Szerlip, MD, FACP, FCCP, FASN, FNKF

Hypertension: What s new since JNC 7. Harold M. Szerlip, MD, FACP, FCCP, FASN, FNKF Hypertension: What s new since JNC 7 Harold M. Szerlip, MD, FACP, FCCP, FASN, FNKF Disclosures Spectral Diagnostics Site investigator Eli Lilly Site investigator ACP IM ITE writing committee NBME Step

More information

Update on Current Trends in Hypertension Management

Update 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 information

Modern Management of Hypertension: Where Do We Draw the Line?

Modern 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 information

New Hypertension Guidelines. Kofi Osei, MD

New 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 information

Management of Hypertension. Ahmed El Hawary MD Suez Canal University

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

More information

Evolving 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) 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 information

4/4/17 HYPERTENSION TARGETS: WHAT DO WE DO NOW? SET THE STAGE BP IN CLINICAL TRIALS?

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

More information

Hypertension (JNC-8)

Hypertension (JNC-8) Hypertension (JNC-8) Southern California University of Health Sciences Physician Assistant Program Management and Treatment of Hypertension April 17, 2018, presented by Ezra Levy, Pharm.D.! The 8 th Joint

More information

Hypertension CHAPTER-I CARDIOVASCULAR SYSTEM. Dr. K T NAIK Pharm.D Associate Professor Department of Pharm.D Krishna Teja Pharmacy College, Tirupati

Hypertension CHAPTER-I CARDIOVASCULAR SYSTEM. Dr. K T NAIK Pharm.D Associate Professor Department of Pharm.D Krishna Teja Pharmacy College, Tirupati CHAPTER-I CARDIOVASCULAR SYSTEM Hypertension SUB: PHARMACOTHERAPEUTICS-I CODE:T0820006 Dr. K T NAIK Pharm.D Associate Professor Department of Pharm.D Krishna Teja Pharmacy College, Tirupati Hypertension

More information

Int. J. Pharm. Sci. Rev. Res., 36(1), January February 2016; Article No. 06, Pages: JNC 8 versus JNC 7 Understanding the Evidences

Int. 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 information

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 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 information

Hypertension Management Focus on new RAAS blocker. Disclosure

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

More information

Egyptian Hypertension Guidelines

Egyptian 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 information

Randomized Design of ALLHAT BP Trial

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

More information

New Lipid Guidelines. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids.

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

More information

Hypertension Update 2009

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

More information

Hypertension and the SPRINT Trial: Is Lower Better

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,

More information

Pharmacologic Management of Hypertension

Pharmacologic Management of Hypertension Current Concepts In Management of Fernando Vega, MD Secondary - Definition Renovascular Disease (The kidney doesn t get impressed by blood pressure) Renovascular stenosis Renal artery stenosis Fibromuscular

More information

Understanding the importance of blood pressure control An overview of new guidelines: How do they impact daily current management?

Understanding the importance of blood pressure control An overview of new guidelines: How do they impact daily current management? Understanding the importance of blood pressure control An overview of new guidelines: How do they impact daily current management? Slides presented during CDMC in Almaty, Kazakhstan on Saturday April 12,

More information

Objective & Outline. How the JNC Process Has Evolved. Expertise Represented on JNC 8 Panel

Objective & Outline. How the JNC Process Has Evolved. Expertise Represented on JNC 8 Panel Implementation: Joint National Committee on High Blood Pressure JNC 8 Joel Handler, MD Kaiser Permanente Care Management Institute Hypertension Lead Southern California Permanente Group Objective & Outline

More information

Hypertension Guidelines: Lessons for Primary Care. Paul A James MD Professor and Chair Department of Family Medicine University of Washington

Hypertension Guidelines: Lessons for Primary Care. Paul A James MD Professor and Chair Department of Family Medicine University of Washington Hypertension Guidelines: Lessons for Primary Care Paul A James MD Professor and Chair Department of Family Medicine University of Washington Disclaimer and Financial Disclosure I have no financial interests

More information

Management of Hypertension in Women

Management 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 information

Reframe the Paradigm of Hypertension treatment Focus on Diabetes

Reframe the Paradigm of Hypertension treatment Focus on Diabetes Reframe the Paradigm of Hypertension treatment Focus on Diabetes Paola Atallah, MD Lecturer of Clinical Medicine SGUMC EDL monthly meeting October 25,2016 Overview Physiopathology of hypertension Classification

More information

hypertension Head of prevention and control of CVD disease office Ministry of heath

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

More information

Pre-ALLHAT Drug Use. Diuretics. ß-Blockers. ACE Inhibitors. CCBs. Year. % of Treated Patients on Medication. CCBs. Beta Blockers.

Pre-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 information

ALLHAT. ALLHAT Antihypertensive Trial Results by Baseline Diabetic & Fasting Glucose Status

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,

More information

SAURIN GANDHI, AZCOM Evidence-Based Guideline for the Management of High Blood Pressure in Adults (JNC 8)

SAURIN GANDHI, AZCOM Evidence-Based Guideline for the Management of High Blood Pressure in Adults (JNC 8) 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults (JNC 8) Background HTN is the most common condition seen in primary care and leads to MI, stroke, renal failure, and death

More information

Todd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM

Todd 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 information

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 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 information

Controlling Hypertension in Primary Care: Hitting a moving target?

Controlling 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 information

Brent M. Egan, MD Professor of Medicine USCSOM Greenville

Brent 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 information

Long-Term Care Updates

Long-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 information

Approach to patient with hypertension. Dr. Amitesh Aggarwal

Approach to patient with hypertension. Dr. Amitesh Aggarwal Approach to patient with hypertension Dr. Amitesh Aggarwal Definition A systolic blood pressure ( SBP) >139 mmhg and/or A diastolic (DBP) >89 mmhg. Based on the average of two or more properly measured,

More information

Difficult to Treat Hypertension

Difficult 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 information

Management of Hypertension in special groups. DR-Mohammed Salah Assistant Lecturer of Cardiology Mansoura University

Management 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 information

APPENDIX D: PHARMACOTYHERAPY EVIDENCE

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

More information

HYPERTENSION MANAGEMENT IN ELDERLY POPULATIONS

HYPERTENSION 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 information

Secondary Hypertension: A Real World Approach

Secondary Hypertension: A Real World Approach Secondary Hypertension: A Real World Approach Evan Brittain, MD December 7, 2012 Kingston, Jamaica Disclosures None Real World Causes Renovascular Hypertension Endocrine Obstructive Sleep Apnea Pseudosecondary

More information

Which antihypertensives are more effective in reducing diastolic hypertension versus systolic hypertension? May 24, 2017

Which antihypertensives are more effective in reducing diastolic hypertension versus systolic hypertension? May 24, 2017 Which antihypertensives are more effective in reducing diastolic hypertension versus systolic hypertension? May 24, 2017 The most important reason for treating hypertension in primary care is to prevent

More information

Treating Hypertension in 2018: What Makes the Most Sense Today?

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

More information

Management of Difficult or Resistant Hypertension in General Practice

Management of Difficult or Resistant Hypertension in General Practice Management of Difficult or Resistant Hypertension in General Practice JNC 7 Guidelines (2003) Classification of Blood Pressure Category SBP DBP Normal < 120 or < 80 Prehypertension 120-139 or 80-89 Stage

More information

Best Practices in Cardiac Care: Getting with the Guidelines

Best 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 information

Outcomes and Perspectives of Single-Pill Combination Therapy for the modern management of hypertension

Outcomes and Perspectives of Single-Pill Combination Therapy for the modern management of hypertension Outcomes and Perspectives of Single-Pill Combination Therapy for the modern management of hypertension Prof. Massimo Volpe, MD, FAHA, FESC, Chair of Cardiology, Department of Clinical and Molecular Medicine

More information

Hypertension Guidelines 2017

Hypertension Guidelines 2017 Hypertension Guidelines 2017 (American College of Cardiology and the American Heart Association) In 1977, the 1st comprehensive guideline for detection, evaluation, and management of high BP was published,

More information

Blood pressure treatment target in diabetes. Should it be <130 mmhg?

Blood pressure treatment target in diabetes. Should it be <130 mmhg? Blood pressure treatment target in diabetes Should it be

More information