Todd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM
|
|
- Stewart Hodge
- 5 years ago
- Views:
Transcription
1 Todd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM
2 Faculty Disclosure I have no financial interest to disclose No off-label use of medications will be discussed FIFTH ANNUAL SYMPOSIUM
3 Recognize changes between new JNC 8 and prior JNC guidelines Apply the JNC 8 hypertension guidelines to clinical practice Discuss the contradictions between the new JNC 8 guidelines and other societal guidelines for the treatment of hypertension Comfortably swim in the pool of ambiguity that continues to surround the treatment of hypertension
4 JAMA. 2014;311(5): doi: /jama
5 In the general population aged 60 years, initiate pharmacologic treatment to lower blood pressure (BP) at systolic blood pressure (SBP) 150 mm Hg or diastolic blood pressure (DBP) 90 mm Hg and treat to a goal SBP <150 mm Hg and goal DBP <90 mm Hg. (Strong Recommendation Grade A)
6
7 In the general population aged 60 years, initiate pharmacologic treatment to lower blood pressure (BP) at systolic blood pressure (SBP) 150 mm Hg or diastolic blood pressure (DBP) 90 mm Hg and treat to a goal SBP <150 mm Hg and goal DBP <90 mm Hg. (Strong Recommendation Grade A)
8 In the general population aged 60 years, initiate pharmacologic treatment to lower blood pressure (BP) at systolic blood pressure (SBP) 150 mm Hg or diastolic blood pressure (DBP) 90 mm Hg and treat to a goal SBP <150 mm Hg and goal DBP <90 mm Hg. (Strong Recommendation Grade A) Used to be SBP < 140 mm Hg
9 In the general population aged 60 years, if pharmacologic treatment for high BP results in lower achieved SBP (eg, <140 mm Hg) and treatment is well tolerated and without adverse effects on health or quality of life, treatment does not need to be adjusted. (Expert Opinion Grade E)
10 In the general population aged 60 years, if pharmacologic treatment for high BP results in lower achieved SBP (eg, <140 mm Hg) and treatment is well tolerated and without adverse effects on health or quality of life, treatment does not need to be adjusted. (Expert Opinion Grade E)
11 In the general population aged < 60 years, initiate pharmacologic treatment to lower BP at SBP > 140 mm Hg or DBP 90 mm Hg and treat to a goal SBP < 140 mm or DBP <90 mm Hg. (For ages years, Strong Recommendation Grade A; For ages years, Expert Opinion Grade E)
12 In the population aged 18 years with chronic kidney disease (CKD) or diabetes, initiate pharmacologic treatment to lower BP at SBP 140 mm Hg or DBP 90 mm Hg and treat to goal SBP <140 mm Hg and goal DBP <90 mm Hg. (Expert Opinion Grade E)
13 In the population aged 18 years with chronic kidney disease (CKD) or diabetes, initiate pharmacologic treatment to lower BP at SBP 140 mm Hg or DBP 90 mm Hg and treat to goal SBP <140 mm Hg and goal DBP <90 mm Hg. (Expert Opinion Grade E)
14 In the population aged 18 years with chronic kidney disease (CKD) or diabetes, initiate pharmacologic treatment to lower BP at SBP 140 mm Hg or DBP 90 mm Hg and treat to goal SBP <140 mm Hg and goal DBP <90 mm Hg. (Expert Opinion Grade E) Used to be goal < 130/80 mm Hg
15 In the general nonblack population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB). (Moderate Recommendation Grade B)
16 In the general nonblack population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB). (Moderate Recommendation Grade B)
17 In the general nonblack population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB). (Moderate Recommendation Grade B) Beta-blockers are downgraded to fourth line therapy
18 In the general black population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or CCB. (For general black population: Moderate Recommendation Grade B; for black patients with diabetes: Weak Recommendation Grade C)
19 In the population aged 18 years with CKD, initial (or add-on) antihypertensive treatment should include an ACEI or ARB to improve kidney outcomes. This applies to all CKD patients with hypertension regardless of race or diabetes status. (Moderate Recommendation Grade B)
20 In the population aged 18 years with CKD, initial (or add-on) antihypertensive treatment should include an ACEI or ARB to improve kidney outcomes. This applies to all CKD patients with hypertension regardless of race or diabetes status. (Moderate Recommendation Grade B)
21 In the population aged 18 years with CKD, initial (or add-on) antihypertensive treatment should include an ACEI or ARB to improve kidney outcomes. This applies to all CKD patients with hypertension regardless of race or diabetes status. (Moderate Recommendation Grade B)
22 In the population aged 18 years with CKD, initial (or add-on) antihypertensive treatment should include an ACEI or ARB to improve kidney outcomes. This applies to all CKD patients with hypertension regardless of race or diabetes status. (Moderate Recommendation Grade B) What kills patients with CKD? Cardiovascular disease.
23
24 There is no evidence that ACEI or ARB improve cardiovascular outcomes or mortality in hypertensives with CKD
25 If goal BP is not reached within a month of treatment, increase the dose of the initial drug or add a second drug from one of the classes in recommendation #6 (thiazide-type diuretic, CCB, ACEI, or ARB). If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. If goal BP cannot be reached using only the drugs in recommendation #6, antihypertensive drugs from other classes can be used. (Expert Opinion Grade E)
26 These recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.
27 Adults >60: 150/90 Adults < 60: 140/90 Adults with CKD or DM: 140/90 Adults with CKD: Nonblack adults: Black adults: Not at target BP: ACEI/ARB CCB, diuretic, ACEI/ARB CCB, diuretic titrate every month, CCB, diuretic, ACEI/ARB
28 Adults >60: 150/90 Adults < 60: 140/90 Adults with CKD or DM: 140/90 Adults with CKD: Nonblack adults: Black adults: Not at target BP: ACEI/ARB CCB, diuretic, ACEI/ARB CCB, diuretic titrate every month, CCB, diuretic, ACEI/ARB
29
30
31 SBP > 150 mm Hg treatment initiation threshold and SBP < 150 mm Hg treatment target applies to adults > 80 years of age (not > 60 years) For nonblack patients < 60 years of age, ACEI or ARB recommend as first line therapy (not CCB or thiazide-type diuretic)
32 SBP > 150 mm Hg treatment initiation threshold and SBP < 150 mm Hg treatment target applies to adults > 80 years of age (not > 60 years)
33 In fact, the JNC 8 guidelines disagree with American Society of Hypertension, American Heart Association, Canadian, British and European guidelines with regard to the treatment of hypertension in persons aged years of age
34 In fact, the JNC 8 guidelines disagree with American Society of Hypertension, American Heart Association, Canadian, British and European guidelines with regard to the treatment of hypertension in persons aged years of age
35
36
37 Hypertension treatment guidelines: Initiate treatment based upon blood pressure Cholesterol treatment guidelines: Initiate treatment based upon estimated risk for cardiovascular disease (risk estimator includes blood pressure!)
38 Neaton JD, Wentworth D; Multiple Risk Factor Intervention Trial Research Group. Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease. Overall findings and differences by age for 316,099 white men. Arch Intern Med. 1992;152:56-64.
39 Level of Evidence Strength of Recommendation Number A Strong High quality trials B Moderate Weaker trials C Weak Observational data D Against Harm! E Expert opinion No data
40 Level of Evidence Strength of Recommendation Number A Strong 1 B Moderate 2 C Weak 1 D Against 0 E Expert opinion 5
41 Level of Evidence Strength of Recommendation Number A Strong 1 B Moderate 2 C Weak 1 D Against 0 E Expert opinion 5 THE ONLY GRADE A RECOMMENDATION IS THE ONE THAT DISAGREES WITH EVERY OTHER GUIDELINE!
42
43 How good are you at measuring blood pressure?
44 How good are you at measuring blood pressure?
45 Manual sphygmomanometer Correct cuff size (bladder > 80% of arm circumference) Seated quietly 5 min, back supported, feet on floor Arm supported at heart level Palpate SBP first At least 2 measurements, both arms, + one leg Sometimes this is not good enough The 7 th Report of the Joint National Committee on the Detection, Prevention, Evaluation and Treatment of High Blood Pressure, JAMA
46 A 75-year old woman with hypertension. For 10+ years she has had office SBPs of 160+ mmhg, but she refuses antihypertensives. No angina, dyspnea, or claudication. No other cardiovascular risk factors or cardiovascular disease. Exam: BP 166/90 HR 94. BMI 22. Anxious. Fundoscopic exam normal. Carotids normal. Lungs clear. Heart: PMI nl, S1S2, no gallop, basal early 2/6 SEM, extremity pulses normal, no edema, neurological exam normal. ECG NSR & no evidence of LVH. egfr > 60. Urinalysis normal. Next step? Re-check BP in your office in 4 weeks, Order 24-hour ambulatory blood pressure monitor Initiate antihypertensive therapy Refer for cardiac stress test Trial of anti-anxiety medication
47 Option B is the correct choice. It would be unusual for a patient to have a 10-year history of severe hypertension and no evidence of target organ damage. This case is suspicious for white coat hypertension, even more so given the anxiety and relative tachycardia, and an ambulatory BP monitor should be ordered to determine the patient s 24-hour mean BP.
48 Indications For the Use of Ambulatory Blood Pressure Monitoring White coat hypertension Informing equivocal treatment decisions Evaluation of nocturnal hypertension Evaluation of drug-resistant hypertension Determining efficacy of treatment over 24 hours Evaluation of symptomatic hypotension Evaluation of unusual variability* JNC 7, JAMA *Peter Rothwell, Lancet Thomas G Pickering
49 24-hour Ambulatory BP > 135/85 > 125/75 < 135/85 < 125/75 Pickering TG et al. J Am Soc Hypertens. 2010;4(2) Masked Hypertension True Normotension True Hypertension White Coat Hypertension < 140/90 > 140/90 < 130/80 > 130/80 Office Blood Pressure
50 Sensitivity Specificity Hodgkinson J, Mant J, Martin U, et al. Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review. BMJ 2011; 342: d3621.
51 Sensitivity 86% (95% CI 81 89) Specificity 46% (95% CI 33 59) Hodgkinson J, Mant J, Martin U, et al. Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review. BMJ 2011; 342: d3621.
52 Sensitivity Specificity masked HTN white coat HTN Hodgkinson J, Mant J, Martin U, et al. Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review. BMJ 2011; 342: d3621.
53 Schettini et al. Hypertension 1999;34:
54 The current use of clinic BP measurements results in high rates of misclassification Results in younger people who are at risk for complications of HTN being undertreated Results in older people who are at risk for complications of HTN treatment being overtreated
55 Medicare, United Health Care: White coat hypertension BCBS, Aetna: White coat hypertension, resistant hypertension, hypertensive individuals with hypotensive symptoms, episodic hypertension, suspected autonomic dysfunction
56
57
58 Adults >60: 150/90 Adults < 60: 140/90 Adults with CKD or DM: 140/90 Adults with CKD: Nonblack adults: Black adults: Not at target BP: ACEI/ARB CCB, diuretic, ACEI/ARB CCB, diuretic titrate every month, CCB, diuretic, ACEI/ARB
59 Relying solely on office pressures overtreats the elderly and undertreats the young Consider in cases of white coat hypertension, resistant hypertension, hypertensive individuals with hypotensive symptoms, episodic hypertension, suspected autonomic dysfunction
60 Todd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM
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 informationManagement of Hypertension in special groups. DR-Mohammed Salah Assistant Lecturer of Cardiology Mansoura University
Management of Hypertension in special groups BY DR-Mohammed Salah Assistant Lecturer of Cardiology Mansoura University AGENDA SPECIAL GROUPS SPECIFIC DRUDS FOR SPECIAL GROUPS TARGET BP FOR SPECIAL GROUPS:
More 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 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 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 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 informationWhat s In the New Hypertension Guidelines?
American College of Physicians Ohio/Air Force Chapters 2018 Scientific Meeting Columbus, OH October 5, 2018 What s In the New Hypertension Guidelines? Max C. Reif, MD, FACP Objectives: At the end of the
More informationEgyptian Hypertension Guidelines
Egyptian Hypertension Guidelines 2014 Egyptian Hypertension Guidelines Dalia R. ElRemissy, MD Lecturer of Cardiovascular Medicine Cairo University Why Egyptian Guidelines? Guidelines developed for rich
More 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 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 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 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 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 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 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 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 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 informationObjectives. Describe results and implications of recent landmark hypertension trials
Hypertension Update Daniel Schwartz, MD Assistant Professor of Medicine Associate Medical Director of Heart Transplantation Temple University School of Medicine Disclosures I currently have no relationships
More informationHypertension in 2015: SPRINT-ing ahead of JNC-8. MAJ Charles Magee, MD MPH FACP Director, WRNMMC Hypertension Clinic
Hypertension in 2015: SPRINT-ing ahead of JNC-8 MAJ Charles Magee, MD MPH FACP Director, WRNMMC Hypertension Clinic Conflits of interest? None Disclaimer The opinions contained herein are not to be considered
More 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 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 informationLong-Term Care Updates
Long-Term Care Updates August 2015 By Darren Hein, PharmD Hypertension is a clinical condition in which the force of blood pushing on the arteries is higher than normal. This increases the risk for heart
More 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 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 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 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 informationTIP. Documentation and coding guide. Disease definitions* Prevalence and statistics associated with HTN**
Documentation and coding guide Disease definitions* HTN is diagnosed when the average of two or more (systolic of diastolic) blood pressure readings are found to be elevated on two or more office visits
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 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 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 informationPrevention 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 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 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 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 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 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 informationApproach 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 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 informationhypertension 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 informationHypertension 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 informationWhich 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 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 informationRenal Denervation. by Walead Latif, DO, MBA, CPE Assistant Clinical Professor Rutgers Medical School
Renal Denervation by Walead Latif, DO, MBA, CPE Assistant Clinical Professor Rutgers Medical School Disclosure Information ACOI Annual Meeting I have the following financial relationships to disclose:
More informationDifficult to Treat Hypertension
Difficult to Treat Hypertension According to Goldilocks JNC 8 Blood Pressure Goals (2014) BP Goal 60 years old and greater*- systolic < 150 and diastolic < 90. (Grade A)** BP Goal 18-59 years old* diastolic
More informationSTANDARD treatment algorithm mmHg
STANDARD treatment algorithm 130-140mmHg (i) At BASELINE, If AVERAGE SBP 1 > 140mmHg If on no antihypertensive drugs: Start 1 drug: If >55 years old / Afro-Caribbean: Calcium channel blocker (CCB) 2 If
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 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 informationSummary of recommendations
Summary of recommendations Measuring blood pressure (BP) Use the recommended technique at every BP reading to ensure accurate measurements and avoid common errs. Pay particular attention to the following:
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 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 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 informationCONCORD INTERNAL MEDICINE HYPERTENSION PROTOCOL
CONCORD INTERNAL MEDICINE HYPERTENSION PROTOCOL Douglas G. Kelling Jr., MD Carmella Gismondi-Eagan, MD, FACP George C. Monroe, III, MD Revised, April 8, 2012 The information contained in this protocol
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 informationHypertension Update Warwick Jaffe Interventional Cardiologist Ascot Hospital
Hypertension Update 2008 Warwick Jaffe Interventional Cardiologist Ascot Hospital Definition of Hypertension Continuous variable At some point the risk becomes high enough to justify treatment Treatment
More 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 informationHypertension diagnosis (see detail document) Diabetic. Target less than 130/80mmHg
Hypertension diagnosis (see detail document) Non-diabetic Diabetic Very elderly (older than 80 years) Target less than 140/90mmHg Target less than 130/80mmHg Consider SBP target less than 150mmHg Non-diabetic
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 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 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 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 informationSAURIN 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 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 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 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 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 informationHypertension 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 informationHypertension (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 informationAdult Hypertension Clinical Practice Guidelines
NATIONAL CLINICAL PRACTICE GUIDELINES Adult Hypertension Clinical Practice Guidelines Reviewed/Approved by the National Guideline Directors: November 2016 Next Review/Approval: November 2018 Developed
More informationHypertension 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 informationHypertension in the Elderly
CardioCase of the Month Hypertension in the Elderly By Luc Trudeau, MD CardioCase Presentation Case Facts Georges is a 63-year-old retired civil servant. He stopped smoking 10 years ago. He denies experiencing
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 informationHypertension Putting the Guidelines into Practice
Hypertension 2017 Putting the Guidelines into Practice Disclosures Relationships with commercial interests: Grants/Research Support: Speakers Bureau/Honoraria: Consulting Fees: Data Safety and Monitoring:
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 informationWe are delighted to have Dr. Roetzheim with us today to discuss Managing Hypertension in Older Adult Patients.
Richard Roetzheim, MD, MSPH is Professor and Chair, Department of Family Medicine at the University of South Florida Morsani College of Medicine. Dr. Roetzheim has considerable experience leading NIH funded
More informationManagement 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 informationHypertension 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 informationHypertension Update 2016 AREEF ISHANI, MD MS CHIEF OF MEDICINE MINNEAPOLIS VA MEDICAL CENTER PROFESSOR OF MEDICINE UNIVERSITY OF MINNESOTA
Hypertension Update 2016 AREEF ISHANI, MD MS CHIEF OF MEDICINE MINNEAPOLIS VA MEDICAL CENTER PROFESSOR OF MEDICINE UNIVERSITY OF MINNESOTA Case 1 What should be your BP goal for an elderly (> 75 yrs of
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 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 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 informationAn Epidemiological Overview
An Epidemiological Overview Cardiovascular disease (CVD) is the leading cause of death in the U.S. In 2005 CVD accounted for approximately 38 percent of all deaths CVD has been the number one killer in
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 informationIncidental Findings; Management of patients presenting with high BP. Phil Swales
Incidental Findings; Management of patients presenting with high BP Phil Swales Consultant Physician Acute & General Medicine University Hospitals of Leicester NHS Trust Objectives The approach to an incidental
More informationHypertension: 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 informationHypertension in the very old. Objectives: Clinical Perspective
Harvard Medical School Hypertension in the very old Ihab Hajjar, MD, MS, AGSF Associate Director, CV Research Lab Assistant Professor of Medicine, Harvard Medical School Objectives: Describe the clinical
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 informationDisclosures. Learning Objectives. Hypertension: a sprint to the finish Ontario Pharmacists Association 1
Disclosures I have no current or past relationships with commercial entities I have received a speaker s fee from the Ontario Pharmacists Association for this learning activity Laura Tsang PharmD Sunnybrook
More informationRESISTENT 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 informationHYPERTENSION IN THE ELDERLY A BALANCED APPROACH. Barry Goldlist October 31, 2014
HYPERTENSION IN THE ELDERLY A BALANCED APPROACH Barry Goldlist October 31, 2014 DISCLOSURE I have not accepted any money for myself from any pharmaceutical company in the 21 st century I have accepted
More informationFirst line treatment of primary hypertension
First line treatment of primary hypertension Dr. Vijaya Musini Assistant Professor, Dept. Anesthesiology, Pharmacology and Therapeutics Manager, Drug Assessment Working Group Therapeutics Initiative Editor,
More informationDifficult-to-Control & Resistant Hypertension. Anthony Viera, MD, MPH, FAHA Professor and Chair
Difficult-to-Control & Resistant Hypertension Anthony Viera, MD, MPH, FAHA Professor and Chair Objectives Define resistant hypertension Discuss evaluation strategy for patient with HTN that appears difficult
More 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 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 informationHypertension Guidelines: Are We Pressured to Change? Oregon Cardiovascular Symposium Portland, Oregon June 6, Financial Disclosures
Hypertension Guidelines: Are We Pressured to Change? Oregon Cardiovascular Symposium Portland, Oregon June 6, 2015 William C. Cushman, MD Professor, Preventive Medicine, Medicine, and Physiology University
More 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 information5.2 Key priorities for implementation
5.2 Key priorities for implementation From the full set of recommendations, the GDG selected ten key priorities for implementation. The criteria used for selecting these recommendations are listed in detail
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 informationRisk Assessment of developing type 2 diabetes mellitus in patient on antihypertensive medication
41 Research Article Risk Assessment of developing type 2 diabetes mellitus in patient on antihypertensive medication Amarjeet Singh*, Sudeep bhardwaj, Ashutosh aggarwal Department of Pharmacology, Seth
More informationRecent Hypertension Guidelines
Recent Hypertension Guidelines Lawrence J. Fine, MD, DrPH, FAHA Division of Cardiovascular Sciences NHLBI/NIH February 19, 2014 Disclosures: Member of Panel Appointed to the Eighth Joint National Committee
More information