Diabetes and Hypertension
|
|
- Everett Mills
- 5 years ago
- Views:
Transcription
1 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 Memphis, Tennessee, USA Ele Ferrannini, William C Cushman. Diabetes and Hypertension: the bad companions. Lancet 2012; 380:
2 Disclosures William C. Cushman, MD Grant/Research Support: NHLBI/NIH, Merck Consultant: Takeda, Merck, Omron, Daiichi- Sankyo, Astra Zeneca
3 Disclaimer Although I was a member of JNC 7 and am a member of the NHLBI JNC 8 expert panel, this presentation is based on my review and interpretation of the literature/my opinions, and not to be construed as reflective of what JNC 8 will recommend.
4 Phenotypic characteristics associated with BP in people without hypertension or diabetes: multiple regression model Sex (female) Menopause Familial HTN Age (+8 yrs) BMI (+4 kg/m 2 ) Waist +(13 cm) HR (+10 bpm) IGT/DM Smoking Mean BP (mmhg) RISC: Relationship between Insulins Sensitivity and Cardiovascular Disease n=1308 Ferrannini, Cushman. Lancet 2012; 380:601 10
5 Phenotypic characteristics associated with hypertension in patients with type 2 diabetes: multiple logistic model Gender (male) Familial HT Age (10 years) BMI (5 kg/m 2 ) Duration (10 years) egfr (20 ml. min m 2 ) Microalbuminuria Macroalbuminuria Background retinopathy Advanced retinopathy Myocardial infarction Stroke Odds ratio (95% C.I.) RIACE: Renal Insufficiency And Cardiovascular Events, n=15,773 Ferrannini, Cushman. Lancet 2012; 380:601 10
6 Cardiovascular Mortality Rate per 10,000 Patient-Years Elevated SBP in Type 2 Diabetes Increases Cardiovascular Risk Elevated SBP increases risk of CV death almost twofold in diabetic vs nondiabetic patients Nondiabetic patients Diabetic patients < Stamler J et al. Diabetes Care. 1993;16: SBP (mm Hg) MRFIT
7 Schematic representation of the intracellular insulin signaling pathways Hyperinsulinaemia Cell membrane Receptor Insulin secretion Intracellular signalling pathways Insulin resistance feedback Glucose disposal B C Effector systems B,C: non-glucose effectors
8 Vascular Actions of Insulin Potentially positive Potentially negative Stimulation of nitric oxide synthase Inhibition of nuclear factor kappa B Inhibition of platelet aggregation Anti-inflammatory Antithrombotic Hypertrophy vis mitogen-activated protein kinase Stimulation of endothelin-1 Membrane hyperpolarization Adrenergic activation Antinatriuresis Stimulation of plasminogen activator inhibitor- 1 Reactive oxygen species generation Smooth muscle cell proliferation Vasoconstriction Extended QTc interval Fluid retention Prothrombotic
9 Why is it important not to intensify medications to reduce BP below the level proven in trials? It identifies a much larger proportion of the population as having hypertension and presumably needing drug therapy. Those previously classified as HTN require more drugs to achieve lower BP goals. Treating to lower BP levels may be harmful (J-curve?). If neither beneficial nor harmful, resources would be wasted and patient adherence may suffer.
10 RCTs Testing BP Goals In Hypertensive Diabetic Patients Trial n Duration (years) SBP goal, mmhg DBP goal, mmhg Mean BP, less intense, mmhg Mean BP, more intense, mmhg Outcome Risk Reduction SHEP <148 none 155/72 146/68 Syst-Eur <150 none 162/82 153/78 HOT 1,501 3 none <80 148/85 144/81 UKPDS 1, <150 <85 154/87 144/82 ABCD none <75 138/86 132/78 ACCORD 4, <120 none Stroke 22% (ns) CVD 34% CHD 56% Stroke 69% CVD 62% CVD 51% MI 50% Stroke 30% (ns) CV death 67% DM-related 34% deaths 32% Stroke 44% Microvasc 37% Renal (1º) nc Microvasc nc Death 49% CVD ns CVD (1º) 12% (ns) Stroke 41%
11 ACCORD BP Trial: Systolic BP (mean + 95% CI) Mean # Meds Intensive: Standard: Average after 1 st year: Standard vs Intensive, Delta = 14.2 N RZ: SBP <120 vs <140 DBP for the same time interval averaged 70 & 64 mm Hg (Delta = 6 mm Hg) Cushman, et al. N Engl J Med. 2010;362:
12 Intensive Events (%/yr) Standard Events (%/yr) HR (95% CI) P Primary 208 (1.87) 237 (2.09) 0.88 ( ) 0.20 Total Mortality 150 (1.28) 144 (1.19) 1.07 ( ) 0.55 Cardiovascular Deaths 60 (0.52) 58 (0.49) 1.06 ( ) 0.74 Nonfatal MI 126 (1.13) 146 (1.28) 0.87 ( ) 0.25 Nonfatal Stroke 34 (0.30) 55 (0.47) 0.63 ( ) 0.03 Total Stroke 36 (0.32) 62 (0.53) 0.59 ( ) 0.01 Also examined Fatal/Nonfatal HF (HR=0.94, p=0.67), a composite of fatal coronary events, nonfatal MI and unstable angina (HR=0.94, p=0.50) and a composite of the primary outcome, revascularization and unstable angina (HR=0.95, p=0.40)
13 Nonfatal Stroke Total Stroke Patients with Events (%) HR = % CI ( ) P=0.03 Patients with Events (%) HR = % CI ( ) P=0.01 Stroke 1 of 8 2º CVD outcomes and relatively uncommon P values not corrected for multiple comparisons NNT = Years Post-Randomization Years Post-Randomization Cushman, et al. N Engl J Med. 2010;362:
14 ADVANCE BP Trial 11,140 patients with type 2 diabetes randomized to addition of indapamide + perindopril vs PBO on usual therapy. Significant 14% reduction in mortality (stopped early) and 9% reduction of combined macro- and microvascular outcomes, but neither significant alone. Mean SBP in intensive group was 135 mm Hg, similar to mean SBP in ACCORD standard BP group. Patel, et al. Lancet 2007;370:
15 Blood Pressure Goals in Patients with Diabetes and Hypertension Clinical trial evidence suggests to me that BP <140/85 mm Hg is a reasonable therapeutic goal in patients with type 2 diabetes mellitus. This is my opinion and not to be assumed to represent what JNC 8 will say.
16 Treatment of Hypertension in Diabetes Mellitus Lifestyle interventions for: Prevention Treatment Drug treatment
17 Diabetes subgroup analyses Is there a difference in the treatment effect of commonly used blood pressure lowering regimens between patients with and without diabetes?
18 Heart Failure BP (mmhg) Favours first listed Favours second listed RR(95%CI) ACE-I vs. D/BB Diabetes No diabetes Overall CA vs. D/BB Diabetes No diabetes Overall ACE-I vs. CA Diabetes No diabetes Overall 2.5/ / / / / / (0.55,1.59) 1.09 (0.95,1.25) p homog = (1.01,1.61) 1.33 (1.16,1.52) p homog = (0.67,1.27) 0.86 (0.73,1.01) p homog = Risk ratio
19 Major CVD BP (mmhg) Favours first listed Favours second listed RR(95%CI) ACE-I vs. D/BB Diabetes No diabetes Overall CA vs. D/BB Diabetes No diabetes Overall ACE-I vs. CA Diabetes No diabetes Overall 2.2/ / / / / / (0.74,1.11) 1.04 (0.98,1.04) p homog = (0.95,1.10) 1.04 (0.99,1.10) p homog = (0.79,1.07) 0.99 (0.92,1.07) p homog = Risk ratio
20 Conclusions (1) Similar proportional risk reductions achieved with regimens based on ACE inhibitors, calcium antagonists and diuretics/beta-blockers (from both placebo controlled and head-to-head comparisons) More intensive blood pressure lowering regimens may, however, be of particular benefit in patients with diabetes
21 Conclusions (2) Little evidence from these analyses that any drug class provides special protection against macrovascular events among patients with diabetes Clinicians might reasonably use any agent for first line therapy in patients with diabetes Many patients are likely to require two or more agents
22 Robert E. Lamb, PharmD ACCOMPLISH Study End Points in Patients With Diabetes (n=6,946) Characteristic Favors B+A Favors B+H Hazard Ratio (95% CI) p-value Primary end point* 0.79 ( ).003 Fatal and non-fatal MI 0.85 ( ).283 Stroke 0.91 ( ).607 Cardiovascular (CV) death 0.84 ( ).312 Coronary revascularization 0.80 ( ).024 Clinical coronary event** 0.73 ( ).013 CV death + MI + stroke 0.84 ( ).085 Hospitalized HF 1.11 ( ).545 All-cause death 1.02 ( ).887 Renal end point 0.53 ( ) <.001 0,25 0,50 0,75 1,00 1,25 1,50 Hazard Ratio * Time to first event, defined as a composite of CV events or death from CV causes ** MI + Hospitalized unstable angina + Sudden cardiac death > 50% increase in serum creatinine with final value above normal range MI=myocardial infarction; HF=heart failure B: benazepril 40 mg/d A: amlodipine 5-10 mg/d H: HCTZ mg/d Adapted from: Weber MA, et al. J Am Coll Cardiol. 2010;56:77-85
23 ALLHAT Diabetics & Nondiabetics (History) Amlodipine/Chlorthalidone Relative Risk and 95% Confidence Intervals Diabetics Nondiabetics CHD 0.99 (0.87, 1.13) Mortality 0.96 (0.87, 1.07) Stroke 0.90 (0.75, 1.08) Heart Failure 1.42 (1.23, 1.64) Combined CVD 1.06 (0.98, 1.15) ESRD 1.30 (0.98, 1.73) 0.97 (0.86,1.09) 0.95 (0.87, 1.04) 0.96 (0.81, 1.14) 1.33 (1.16, 1.52) 1.02 (0.96, 1.09) 0.86 (0.60, 1.25) Favors Favors Favors Favors Amlodipine Chlorthal Amlodipine Chlorthal There is no difference in treatment group effect by baseline history of diabetes. JAMA 2002;288:
24 ALLHAT Diabetics & Nondiabetics (History) Lisinopril/Chlorthalidone Relative Risk and 95% Confidence Intervals Diabetics Nondiabetics CHD 1.00 (0.87, 1.14) 0.99 (0.88, 1.11) Mortality 1.02 (0.91, 1.13) 1.00 (0.91, 1.09) Stroke 1.07 (0.90, 1.28) 1.23 (1.05, 1.44) Heart Failure 1.22 (1.05, 1.42) 1.20 (1.04, 1.38) Combined CVD 1.08 (1.00, 1.17) 1.12 (1.04, 1.19) ESRD 1.17 (0.87, 1.57) 1.05 (0.74, 1.48) Favors Favors Lisinopril Chlorthal Favors Favors Lisinopril Chlorthal There is no difference in treatment group effect by baseline history of diabetes. JAMA 2002;288:
25 Network Meta-analysis of Diabetes Incidence with Antihypertensive Drug Classes 22 trials, n=143,153 Elliott WJ, Meyer PM. Lancet 2007; 369:
26 Differences in Diabetes Incidence Between Antihypertensive Drugs Thiazide-type diuretic &/or b-blocker: diabetes incidence <1% to 2% higher vs placebo or CCB over several years. Difference doesn t worsen. ACEI or ARB: diabetes incidence 0% to 2% lower than PBO or CCB in large trials. Average difference between drugs usually no more than 2-6 mg/dl.
27 Do differences in glucose levels or diabetes incidence with AHT drugs produce detectable changes in CVD outcomes?
28 Long-Term Effects of Incident Diabetes Mellitus on Cardiovascular Outcomes in People Treated for Hypertension: The ALLHAT Diabetes Extension Study Chlorthalidone Amlodipine Lisinopril Circ Cardiovasc Qual Outcomes. 2012;5:
29 Initial Combinations of Antihypertensive Medications in Diabetes Mellitus* Diuretics ACE inhibitors or ARBs Calcium antagonists * Compelling indications may modify this.
30 Diabetes and Hypertension Hypertension is present in >2/3 of patients with type 2 diabetes. The development of hypertension can precede and predict the development of dysglycaemia, and impaired glucose tolerance can predict the development of HTN. Hypertension and diabetes confer a much enhanced risk of cardiovascular disease than either one alone. Many pathophysiological mechanisms may underlie this association, including insulin resistance, the stimulatory effect of hyperinsulinaemia on sympathetic drive, smooth muscle growth, sodium fluid retention, and the excitatory effect of hyperglycaemia on RAAS.
31 Diabetes and Hypertension Clinical trial evidence suggests that BP <140/85 mm Hg is a reasonable therapeutic goal in patients with type 2 diabetes mellitus. Treatment-induced CVD risk reduction in people with diabetes is not different from that of patients with HTN without diabetes. In patients with diabetes, a combination of a RAS-blocker and a thiazide-type diuretic might be the most reasonable initial antihypertensive regimen, although CCBs and CCB-ACEI combination are also effective. The effects of antihypertensive drugs on glucose metabolism should probably be a minor consideration relative to their effects on major CVD outcomes.
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 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 informationALLHAT. ALLHAT Antihypertensive Trial Results by Baseline Diabetic & Fasting Glucose Status
ALLHAT Antihypertensive Trial Results by Baseline Diabetic & Fasting Glucose Status 1 Introduction and Background Clinical trials have reported reduction in CV events with diuretics, CCBs, ACE inhibitors,
More informationHypertension and Diabetes Should we be SPRINTING or Reaching an ACCORD?
Hypertension and Diabetes Should we be SPRINTING or Reaching an ACCORD? Suzanne Oparil, MD Distinguished Professor of Medicine, Professor of Cell, Developmental and Integrative Biology Director, Vascular
More informationUnderstanding 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 informationThe Latest Generation of Clinical
The Latest Generation of Clinical Guidelines: HTN and HLD Dave Brackett Clinical Guideline Purpose Uniform approach Awareness of key details Diagnosis Treatment Monitoring Evidence based approach Inform
More information2/10/2014. Hypertension: Highlights of Hypertension Guidelines: Making the Most of Limited Evidence. Issues with contemporary guidelines
Hypertension: 214 Highlights of Hypertension Guidelines: Making the Most of Limited Evidence Michael A, Weber, MD Editor-in-Chief, The Journal of Clinical Hypertension, Professor of Medicine, Division
More informationCedars 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
More informationHypertension Management: A Moving Target
9:45 :30am Hypertension Management: A Moving Target SPEAKER Karol Watson, MD, PhD, FACC Presenter Disclosure Information The following relationships exist related to this presentation: Karol E. Watson,
More informationHypertension Update Clinical Controversies Regarding Age and Race
Hypertension Update Clinical Controversies Regarding Age and Race Allison Helmer, PharmD, BCACP Assistant Clinical Professor Auburn University Harrison School of Pharmacy July 22, 2017 DISCLOSURE/CONFLICT
More informationDISCLOSURE 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 informationHYPERTENSION GUIDELINES WHERE ARE WE IN 2014
HYPERTENSION GUIDELINES WHERE ARE WE IN 2014 Donald J. DiPette MD FACP Special Assistant to the Provost for Health Affairs Distinguished Health Sciences Professor University of South Carolina University
More informationADVANCES IN MANAGEMENT OF HYPERTENSION
Advances in Management of Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Current Status of Prevalence 29%; Blacks 33.5%
More informationTreating 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 informationALLHAT Role of Diuretics in the Prevention of Heart Failure - The Antihypertensive and Lipid- Lowering Treatment to Prevent Heart Attack Trial
1 ALLHAT Role of Diuretics in the Prevention of Heart Failure - The Antihypertensive and Lipid- Lowering Treatment to Prevent Heart Attack Trial Davis BR, Piller LB, Cutler JA, et al. Circulation 2006.113:2201-2210.
More informationADVANCE post trial ObservatioNal Study
Hot Topics in Diabetes 50 th EASD, Vienna 2014 ADVANCE post trial ObservatioNal Study Sophia Zoungas The George Institute The University of Sydney Rationale and Study Design Sophia Zoungas The George Institute
More informationT. 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 informationRandomized Design of ALLHAT BP Trial
Outcomes in Hypertensive Black and Nonblack Patients Treated with Chlorthalidone, Amlodipine, and Lisinopril* *Wright JT, Dunn JK, Cutler JA et al. JAMA 2005:293:1595-1608. 42,418 High-risk hypertensive
More informationADVANCES IN MANAGEMENT OF HYPERTENSION
Prevalence 29%; Blacks 33.5% About 72.5% treated; 53.5% uncontrolled (>140/90) Risk for poor control: Latinos, Blacks, age 18-44 and 80,
More informationObjectives. Describe results and implications of recent landmark hypertension trials
Hypertension Update Daniel Schwartz, MD Assistant Professor of Medicine Associate Medical Director of Heart Transplantation Temple University School of Medicine Disclosures I currently have no relationships
More informationALLHAT. Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic
1 U.S. Department of Health and Human Services National Institutes of Health Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker
More informationAntihypertensive Trial Design ALLHAT
1 U.S. Department of Health and Human Services Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic National Institutes
More informationManaging 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 informationPreventing and Treating High Blood Pressure
Preventing and Treating High Blood Pressure: Finding the Right Balance of Integrative and Pharmacologic Approaches Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Blood Pressure
More informationJNC 8 -Controversies. Sagren Naidoo Nephrologist CMJAH
JNC 8 -Controversies Sagren Naidoo Nephrologist CMJAH Joint National Committee (JNC) Panel appointed by the National Heart, Lung, and Blood Institute (NHLBI) First guidelines (JNC-1) published in 1977
More informationMANAGEMENT OF HYPERTENSION: TREATMENT THRESHOLDS AND MEDICATION SELECTION
Management of Hypertension: Treatment Thresholds and Medication Selection Robert B. Baron, MD MS Professor and Associate Dean Declaration of full disclosure: No conflict of interest Presentation Goals
More informationHypertension targets: sorting out the confusion. Brian Rayner, Division of Nephrology and Hypertension, University of Cape Town
Hypertension targets: sorting out the confusion Brian Rayner, Division of Nephrology and Hypertension, University of Cape Town Historical Perspective The most famous casualty of this approach was the
More informationModern Management of Hypertension
Modern Management of Hypertension Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Current Status of Hypertension Prevalence
More informationHypertension Update 2009
Hypertension Update 2009 New Drugs, New Goals, New Approaches, New Lessons from Clinical Trials Timothy C Fagan, MD, FACP Professor Emeritus University of Arizona New Drugs Direct Renin Inhibitors Endothelin
More informationDysglycaemia 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
More informationModern Management of Hypertension: Where Do We Draw the Line?
Modern Management of Hypertension: Where Do We Draw the Line? Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Blood Pressure
More 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 informationTalking about blood pressure
Talking about blood pressure Mrs Khan 56 BP 158/99 BMI 32 Total cholesterol 5.4 (HDL 0.8) HbA1c 43 She has been promising to do more exercise and eat more healthily for the last 2 years but her weight
More information4/4/17 HYPERTENSION TARGETS: WHAT DO WE DO NOW? SET THE STAGE BP IN CLINICAL TRIALS?
HYPERTENSION TARGETS: WHAT DO WE DO NOW? MICHAEL LEFEVRE, MD, MSPH PROFESSOR AND VICE CHAIR DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE UNIVERSITY OF MISSOURI 4/4/17 DISCLOSURE: MEMBER OF THE JNC 8 PANEL
More informationThe 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
More informationNone. 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 informationNew Lipid Guidelines. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids.
PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Disclosure No relevant
More informationTreating Hypertension in 2018: What Makes the Most Sense Today?
Treating Hypertension in 2018: What Makes the Most Sense Today? Daniel Blanchard, MD Professor of Medicine UC San Diego Cardiovascular Center La Jolla, California 1 2 Speaker Disclosures Consultant and/or
More informationManaging Hypertension in 2016
Managing Hypertension in 2016: Where Do We Draw the Line? Disclosure No relevant financial relationships Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine baron@medicine.ucsf.edu
More informationBlood Pressure Targets in Diabetes
Stockholm, 29 th August 2010 ESC Meeting Blood Pressure Targets in Diabetes Peter M Nilsson, MD, PhD Department of Clinical Sciences University Hospital, Malmö Sweden Studies on BP in DM2 ADVANCE RCT (Lancet
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 informationHypertension. Does it Matter What Medications We Use? Nishant K. Sekaran, M.D. M.Sc. Intermountain Heart Institute
Hypertension Does it Matter What Medications We Use? Nishant K. Sekaran, M.D. M.Sc. Intermountain Heart Institute Hypertension 2017 Classification BP Category Systolic Diastolic Normal 120 and 80 Elevated
More 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 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 informationOutcomes 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 informationDisclosures. Hypertension: Nationwide Dilemma. Learning Objectives. What s Currently Recommended? Specific Concerns 3/9/2012
How Should We ACCOMPLISH Good Blood Pressure Control In Our VETS? Disclosures No conflicts of interest to disclose Updates in the Management of HypertensionIn the Elderly Antoine T. Jenkins, Pharm.D.,
More informationObjective & 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 informationHypertension 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
More informationA factorial randomized trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes
A factorial randomized trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes Hypotheses: Among individuals with type 2 diabetes, the risks of major microvascular
More informationUpdate on CVD and Microvascular Complications in T2D
Update on CVD and Microvascular Complications in T2D Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of Miami Miller School of Medicine
More informationHow clinically important are the results of the large trials in hypertension?
How clinically important are the results of the large trials in hypertension? Stéphane LAURENT, MD, PhD, FESC Pharmacology Department and PARCC / INSERM U970 Hôpital Européen Georges Pompidou, Université
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 informationCombination 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 informationUpdate in Cardiology Pharmacologic Management of Cardiovascular Risk. Christopher C. Roe, MSN, ACNP
Update in Cardiology Pharmacologic Management of Cardiovascular Risk Christopher C. Roe, MSN, ACNP Objectives 1. Verbalize understanding of new pharmacologic guidelines in the treatment of hypertension
More informationBlood Pressure Treatment Goals
Blood Pressure Treatment Goals Kenneth Izuora, MD, MBA, FACE Associate Professor UNLV School of Medicine November 18, 2017 Learning Objectives Discuss the recent studies on treating hypertension Review
More informationJNC Evidence-Based Guidelines for the Management of High Blood Pressure in Adults
JNC 8 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults Table of Contents Why Do We Treat Hypertension? Blood Pressure Treatment Goals Initial Therapy Strength of Recommendation
More informationBlood Pressure Targets: Where are We Now?
Blood Pressure Targets: Where are We Now? Diana Cao, PharmD, BCPS-AQ Cardiology Assistant Professor Department of Clinical & Administrative Sciences California Northstate University College of Pharmacy
More informationHypertension Guidelines Michael A. Weber, MD Division of Cardiovascular Medicine State University of New York Downstate Medical Center
Hypertension Guidelines 2016 Michael A. Weber, MD Division of Cardiovascular Medicine State University of New York Downstate Medical Center Speaker Disclosures I disclose that I am a Consultant for: Ablative
More informationAPPENDIX D: PHARMACOTYHERAPY EVIDENCE
Página 1 de 7 APPENDIX D: PHARMACOTYHERAPY EVIDENCE Table D1. Outcome Trials of Antihypertensive Agents Study Drug Regimen N Duration Primary Outcomes Remarks Antihypertensive Therapy vs Placebo SHEP 1991
More informationTreatment 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
More informationMacrovascular Disease in Diabetes
Macrovascular Disease in Diabetes William R. Hiatt, MD Professor of Medicine/Cardiology University of Colorado School of Medicine President, CPC Clinical Research Conflicts CPC Clinical Research (University-based
More informationHypertension and Cardiovascular Disease
Hypertension and Cardiovascular Disease Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or by any means graphic,
More informationIn the Literature 1001 BP of 1.1 mm Hg). The trial was stopped early based on prespecified stopping rules because of a significant difference in cardi
Is Choice of Antihypertensive Agent Important in Improving Cardiovascular Outcomes in High-Risk Hypertensive Patients? Commentary on Jamerson K, Weber MA, Bakris GL, et al; ACCOMPLISH Trial Investigators.
More informationManagement of Hypertension in Women
Management of Hypertension in Women Eliseo J. Pérez-Stable MD Professor of Medicine DGIM, Department of Medicine July 1, 2013 Declaration of full disclosure: No conflict of interest (I have never been
More 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 informationThe 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
More informationEvaluation and Management of Hypertension in Women. Vesna D. Garovic, M.D. Moscow, Russia, December 2016
Evaluation and Management of Hypertension in Women Vesna D. Garovic, M.D. Moscow, Russia, December 2016 2016 MFMER 3508058-1 Women are not small men There is nothing as powerful as an idea whose time has
More informationUpdate sulla terapia antiipertensiva e antiaggregante nel paziente cardiometabolico
Update sulla terapia antiipertensiva e antiaggregante nel paziente cardiometabolico G. Mazzanti UO Cardiologia Ospedale SS. Annunziata, Cento (FE) AUSL di Ferrara Antiplatelet therapy Aspirin Aspirin:
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 informationHYPERTENSION MANAGEMENT IN ELDERLY POPULATIONS
HYPERTENSION MANAGEMENT IN ELDERLY POPULATIONS Michael J. Scalese, PharmD, BCPS, CACP Assistant Clinical Professor Auburn University Harrison School of Pharmacy July 14, 2018 DISCLOSURE/CONFLICT OF INTEREST
More 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 informationDrug-Induced Diabetes May Not Be Harmful But Should Be Prevented. Jeffrey A. Cutler, MD, MPH
Drug-Induced Diabetes May Not Be Harmful But Should Be Prevented Jeffrey A. Cutler, MD, MPH Overview Focus on thiazide-like diuretics (not BB) Diuretic-induced versus diureticassociated diabetes Role of
More informationBlood pressure treatment target in diabetes. Should it be <130 mmhg?
Blood pressure treatment target in diabetes Should it be
More informationManagement of Lipid Disorders and Hypertension: Implications of the New Guidelines
Management of Lipid Disorders and Hypertension Management of Lipid Disorders and Hypertension: Implications of the New Guidelines Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine
More informationManaging HTN in the Elderly: How Low to Go
Managing HTN in the Elderly: How Low to Go Laxmi S. Mehta, MD, FACC The Ohio State University Medical Center Assistant Professor of Clinical Internal Medicine Clinical Director of the Women s Cardiovascular
More informationHow 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
More informationHypertension Controversies: SPRINTing to New Goals
Hypertension Controversies: SPRINTing to New Goals Diana Isaacs, PharmD, BCPS, BC-ADM, CDE Clinical Pharmacy Specialist Cleveland Clinic Lauren Wolfe, PharmD Primary Care Clinical Specialist Cleveland
More information1. 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
More informationIndividual management of arterial hypertension. Doumas Michael, Internist Lecturer, Aristotle University, Thessaloniki
Individual management of arterial hypertension Doumas Michael, Internist Lecturer, Aristotle University, Thessaloniki From Population to Individual Management of Arterial Hypertension Epidemiologic impact
More informationJackson T. Wright, Jr. MD, PhD
DIFFERENTIAL EFFECTS OF BLOOD PRESSURE MEDICATIONS IN BLACK PATIENTS Jackson T. Wright, Jr. MD, PhD Professor of Medicine Program Director, WT Dahms MD Clinical Research Unit Clinical and Translational
More information2014 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 informationMODERN MANAGEMENT OF HYPERTENSION Where Do We Draw the Line? Disclosure. No relevant financial relationships. Blood Pressure and Risk
MODERN MANAGEMENT OF HYPERTENSION Where Do We Draw the Line? Disclosure No relevant financial relationships Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine baron@medicine.ucsf.edu
More informationHypertension Update. Mayo Clinic 90 th Annual Clinical Reviews November 2 nd and 16 th, 2016
Mayo Clinic 90 th Annual Clinical Reviews November 2 nd and 16 th, 2016 Hypertension Update Vincent J. Canzanello, M.D. Consultant, Division of Nephrology and Hypertension Professor or Medicine College
More informationVALUE 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
More informationBrent M. Egan, MD Professor of Medicine USCSOM Greenville
Contemporary Management of Uncontrolled and Treatment Resistant Hypertension Brent M. Egan, MD Professor of Medicine USCSOM Greenville Disclosures (past 3 years): Honoraria: BCBSSC, Medtronic Grant Support:
More informationUpdate 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 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 informationNew 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
More informationCauses of death in Diabetes
Rates of CV events in Diabetes patients Respiratory4.2 Cancer 7.6 Diabetes 1.3 CV disease 17.3 Causes of death in Diabetes 250 200 150 100 50 0 per 10,000 person-years 97 151 243 Framingham 5 X increase
More informationClinical Updates in the Treatment of Hypertension JNC 7 vs. JNC 8. Lauren Thomas, PharmD PGY1 Pharmacy Practice Resident South Pointe Hospital
Clinical Updates in the Treatment of Hypertension JNC 7 vs. JNC 8 Lauren Thomas, PharmD PGY1 Pharmacy Practice Resident South Pointe Hospital Objectives Review the Eighth Joint National Committee (JNC
More informationIs 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
More informationManaging Hypertension in 2018
MANAGING HYPERTENSION IN 2018 How Do We Work With Conflicting Data and Conflicting Guidelines? Disclosure No relevant financial relationships Robert B. Baron, MD MS Professor and Associate Dean UCSF School
More informationHypertension 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 informationHypertension Putting the Guidelines into Practice
Hypertension 2017 Putting the Guidelines into Practice 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
More informationComplications of Diabetes: Screening and Prevention
Complications of Diabetes: Screening and Prevention Dr Steve Cleland Consultant Physician GGH and QEUH Diabetes Staff Education Course June 17 Diabetic Complications Microvascular: Retinopathy Nephropathy
More informationMasked Hypertension. Why Should We Care? Dr. Peter J. Lin Director Primary Care Initiatives - Canadian Heart Research Centre
Masked Hypertension Why Should We Care? Dr. Peter J. Lin Director Primary Care Initiatives - Canadian Heart Research Centre PRESENTER DISCLOSURE Faculty: Dr. Peter Lin Relationships with commercial interests:
More informationPrevention 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
More informationInt. J. Pharm. Sci. Rev. Res., 36(1), January February 2016; Article No. 06, Pages: JNC 8 versus JNC 7 Understanding the Evidences
Research Article JNC 8 versus JNC 7 Understanding the Evidences Anns Clara Joseph, Karthik MS, Sivasakthi R, Venkatanarayanan R, Sam Johnson Udaya Chander J* RVS College of Pharmaceutical Sciences, Coimbatore,
More informationDiabetes 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
More information