Healthcare Implications of Achieving JNC 7 Blood Pressure Goals in Clinical Practice

Transcription

1 CONTINUING EDUCATION Healthcare Implications of Achieving JNC 7 Blood Pressure Goals in Clinical Practice GOAL To provide participants with current information about current blood pressure goals and effective use of antihypertensive agents to achieve these goals. TARGET AUDIENCE This activity is intended for physicians, medical directors, pharmacists, pharmacy directors, primary care physicians, and specialists in internal medicine and cardiology. EDUCATIONAL OBJECTIVES After completing this continuing education activity, the participant should be able to: Review JNC 7 treatment goals and NHANES data illustrating prevalence of uncontrolled treated hypertension. Discuss the economic burden on the healthcare system of uncontrolled hypertension and resulting endorgan damage. Explain the role of combination therapy in achieving JNC 7 goals. Describe the role of RAS inhibitors in combination antihypertensive therapy. CONTINUING MEDICAL EDUCATION ACCREDITATION The University of Cincinnati College of Medicine designates this activity for a maximum of 2 Category 1 credits toward the AMA Physician s Recognition Award. Each physician should claim only those hours that he/she actually spends in the educational activity. The University of Cincinnati College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor medical education for physicians. Release Date: September 1, Expiration Date: September 30, CONTINUING PHARMACY EDUCATION ACCREDITATION Medical World Communications Office of Continuing Professional Education is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program is approved for 2 contact hours (0.2 CEUs) under the ACPE universal program number of H04. Release Date: September 1, Expiration Date: September 1, FUNDING This program is supported by an unrestricted educational grant from Sankyo Pharma Inc. THE AMERICAN JOURNAL OF MANAGED CARE

2 CME/CE QUIZ CME/CE QUESTIONS Continuing Medical Education Accreditation The University of Cincinnati College of Medicine designates this educational activity for a maximum of 2 Category 1 credits toward the AMA Physician s Recognition Award. Each physician should claim only those hours that he/she actually spends in the educational activity. The University of Cincinnati College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor medical education for physicians. Continuing Pharmacy Education Accreditation Medical World Communications Office of Continuing Professional Education is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is approved for 2 contact hours (0.2 CEUs) under the ACPE universal program number of H04. Instructions After reading Healthcare Economics of Achieving JNC 7 Blood Pressure Goals in Clinical Practice, complete the program evaluation and select the 1 best answer to each of the following questions. A statement of continuing education hours will be mailed to those who successfully complete (with a minimum score of 70%) the examination at the conclusion of the program. 1. Ischemic heart disease mortality has been shown to increase linearly with age starting at systolic/diastolic blood pressures of: a) >110/>70 mm Hg b) >115/>75 mm Hg c) >120/>80 mm Hg d) >140/>90 mm Hg 2. Which of the following statements about the findings of the most recent National Health and Nutrition Examination Survey (NHANES) is true? a) The prevalence of hypertension in the United States has decreased. b) The prevalence of hypertension is greatest among Asian Americans. c) Control of hypertension has improved since the previous survey but remains low. d) Control of hypertension has remained the same since the previous survey. 3. Which of the following statements about blood pressure is true? a) Diastolic blood pressure typically increases until about age 50 and then remains the same or declines. b) Systolic blood pressure tends to decline with age. c) In persons >50 years of age, diastolic blood pressure is a better prognostic indicator than systolic blood pressure. d) If a person s blood pressure is normal at age 55, it is likely to remain so. 4. Which of the following is not a feature of the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)? a) It introduces the concept of lifetime risk. b) It emphasizes the importance of systolic blood pressure as a cardiovascular risk factor. c) It introduces a prehypertension category. d) It sets a blood pressure goal of <140/90 mm Hg for patients with diabetes or chronic kidney disease. 5. JNC 7 lists compelling reasons for specific classes of antihypertensive drugs. Diabetes is a compelling indication for all of the following except a(an): a) Thiazide diuretic b) Beta blocker c) Aldosterone antagonist d) Angiotensin AT 1 receptor blocker (ARB) 6. Which of the following is not a JNC 7 recommendation about drug therapy? a) Most patients with stage 1 hypertension should receive an angiotensin-converting enzyme (ACE) inhibitor as initial therapy. b) Most patients with stage 1 hypertension should receive a thiazide diurectic either alone or in combination with another agent. c) Comorbid conditions are an important consideration in selecting therapy. d) Combination therapy is often needed to get to goal blood pressure. 7. The most recent NHANES data show a hypertension control rate in the United States of 31%. The Healthy People 2010 goal is: a) 50% b) 75% c) 85% d) 95% 8. In 2004, the cost of hypertension in the United States was estimated to be: a) $14.0 billion b) $41.5 billion c) $55.5 billion d) $75.0 billion S228 THE AMERICAN JOURNAL OF MANAGED CARE SEPTEMBER 2005

3 CME/CE QUIZ 9. Antihypertensive therapy dramatically reduces cardiovascular morbidity and mortality. The State of Health Care Quality: 2004 report showed the greatest reduction in: a) Stroke b) Myocardial infarction c) Atrial fibrillation d) Heart failure 10. In a recent study of insured patients with diabetes and hypertension, the most frequently used antihypertensive agents were: a) Thiazide diuretics b) ACE inhibitors c) ARBs d) Beta blockers 11. Which of the following statements is true? a) The most recent NHANES data show considerable progress in controlling blood pressure in patients with diabetes. b) The majority of diabetic patients treated in specialized hypertension clinics achieve blood pressure goals. c) A study of patients treated in a hypertension clinic showed that it is more difficult to achieve goal blood pressure in patients with diabetes than in other hypertensive patients. d) In one study, treatment to goal blood pressure in patients with diabetes increased the cost of lifetime treatment. 12. Which of the following statements is false? a) Subjects with isolated diastolic hypertension are at greater risk of cardiovascular events than those with isolated systolic hypertension. b) The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial showed that it is more difficult to achieve goal systolic blood pressure than goal diastolic blood pressure. c) Systolic blood pressure is a major factor in renal outcomes. d) Even patients with blood pressure regarded as optimal may be at increased risk for cardiovascular disease. 13. In the Hypertension Optimal Treatment study, about were able to achieve a goal diastolic blood pressure of 80 mm Hg on monotherapy. a) 25% b) 35% c) 50% d) 65% 14. Which of the following statements about angiotensin II is false? a) It is the hormone chiefly responsible for the effects of the renin-angiotensin-aldosterone system. b) It acts as a growth factor. c) It is a potent vasodilator. d) It has indirect pressor effects. 15. Which of the following statements about ARBs is false? a) They have dose-dependent effects on blood pressure. b) About 50% of patients treated with ARB monotherapy achieve a diastolic blood pressure of < 90 mm Hg. c) They are more effective in controlling blood pressure when combined with a diuretic. d) The incidence of side effects with an ARB is similar to that with an ACE inhibitor. 16. In the Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria study, about of patients who received the 300-mg/day dosage achieved normoalbuminuria. a) One quarter b) One third c) One half d) Two thirds 17. In the Losartan Intervention For Endpoint reduction in hypertension study: a) Blood pressure reduction was greater in the losartan group. b) Blood pressure reduction was greater in the atenolol group. c) Blood pressure reduction was similar in the 2 groups. d) The risk of stroke was greater in the losartan group. 18. The Valsartan Antihypertensive Long-term Use Evaluation showed that: a) Rapid reduction of blood pressure is associated with more favorable outcomes. b) Blood pressure reductions were similar in the losartan and amlodipine groups. c) There were significant differences in cardiac morbidity and mortality in the losartan and amlodipine groups. d) New-onset diabetes occurred more frequently in the losartan group. 19. In a comparison of the starting doses of 4 ARBs, more patients achieved the blood pressure goal of 140/90 mm Hg in the group treated with: a) Valsartan b) Olmesartan c) Irbesartan d) Losartan 20. Overall, clinical trials of ARBs have shown: a) Greater blood pressure lowering efficacy than ACE inhibitors. b) A higher incidence of side effects with ARBs than with ACE inhibitors. c) No significant differences in blood pressure lowering efficacy within the class. d) Both cardiovascular and renal target-organ protection. VOL. 11, NO. 7, SUP. THE AMERICAN JOURNAL OF MANAGED CARE S229

4 CME QUIZ & EVALUATION For Physicians CME TEST FORM Healthcare Implications of Achieving JNC 7 Blood Pressure Goals in Clinical Practice Please circle your answers: 1. a b c d 2. a b c d 3. a b c d 4. a b c d 5. a b c d 6. a b c d 7. a b c d 8. a b c d 9. a b c d 10. a b c d 11. a b c d 12. a b c d 13. a b c d 14. a b c d 15. a b c d 16. a b c d 17. a b c d 18. a b c d 19. a b c d 20. a b c d (PLEASE PRINT CLEARLY) Name/Degree Street City State/ZIP Daytime Phone Fax Sponsored by the University of Cincinnati for 2 hours of Category 1 CME credit. Release Date: September 1, 2005 Expiration Date: September 30, 2006 CME Activity Evaluation Answer Form Instructions: Testing and Grading Procedures 1. Each participant achieving a passing grade of 70% or higher on any examination will receive an official computer form stating the number of CME credits earned. This form should be safeguarded and may be used as documentatio n of credits earned. 2. Participants receiving a failing grade on any exam will be notified and permitted to take 1 reexamination at no cost. 3. All answers should be recorded on the answer form. 4. To receive credit certification electronically, please provide your address. Detach and mail or fax the test portion of this page to: University of Cincinnati, Office of CME, PO Box , Cincinnati, OH ; phone: ; fax: Please print clearly to ensure receipt of CME credit. To take the test on-line, please go to edu/cme. Activity Evaluation How long did it take you to complete this activity? minutes How well did this activity achieve its educational objectives? Very well Well Somewhat Not at all What overall grade would you assign this activity? A B C D Did this activity exhibit promotional bias for any pharmaceutical agents? Yes No Will you make changes in your practice as a result of information presented in this lesson? Yes No Proj A132 S230 THE AMERICAN JOURNAL OF MANAGED CARE SEPTEMBER 2005

5 CE QUIZ For Pharmacists ANSWER CARD INSTRUCTIONS Testing and Grading Procedures 1. Each participant achieving a passing grade of 70% or higher on any examination will receive an official computer form stating the number of CE credits earned. This form should be safeguarded and may be used as documentation of credits earned. 2. Participants receiving a failing grade on any exam will be notified and permitted to take 1 reexamination at no cost. 3. All answers should be recorded on the answer form. Please print clearly to ensure receipt of CE credit. 4. To receive credit certification electronically, please provide your address. Detach and mail completed exam form with your $10.00 payment to Pharmacy Times, 405 Glenn Drive, Suite 4, Sterling, VA ; or fax to Take the test online for FREE at and receive immediate grading and CE credits, and download your CE statement of credit. Please photocopy the test form for additional test takers. Medical World Communications Office of Continuing Professional Education is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is approved for 2 contact hours (0.2 CEUs) under the ACPE universal program number of H04. The program is available for CE credit through September 1, Answer card and evaluation form for Pharmacists follow on page S232. VOL. 11, NO. 7, SUP. THE AMERICAN JOURNAL OF MANAGED CARE S231

6 CE EVALUATION For Pharmacists ANSWER CARD AND EVALUATION FORM Healthcare Implications of Achieving JNC 7 Blood Pressure Goals in Clinical Practice PROGRAM EVALUATION Please mark your level of agreement with the following statements. (4 = Strongly Agree; 0 = Strongly Disagree) 1) Met its stated objectives ) Was well organized ) Contributed to my knowledge ) Presented current and relevant information ) Presented information in a fairly balanced and noncommercial manner ) Offered information useful in my professional practice ) Provided new insights into contemporary pharmacy practice (PLEASE PRINT CLEARLY) Name/Degree Street City State/ZIP Daytime Phone Fax Check (payable to Pharmacy Times) Credit Card (check one) VISA MasterCard American Express SSN - - Credit Card Number Expiration Date Signature (REQUIRED) Sponsored by Medical World Communications Office of Continuing Professional Education for 2 contact hours (0.2 CEUs) of CE credit. Expiration Date: September 1, 2006 Detach and mail completed answer card and evaluation form with your $10.00 payment to: Pharmacy Times 405 Glenn Drive Suite 4 Sterling, VA Or take the quiz online for FREE at ANSWER CARD Please circle your answers: a a a a a a a a a a b b b b b b b b b b c c c c c c c c c c d d d d d d d d d d a a a a a a a a a a b b b b b b b b b b c c c c c c c c c c d d d d d d d d d d PROJ A132 S232 THE AMERICAN JOURNAL OF MANAGED CARE SEPTEMBER 2005

7 SUPPLEMENT POLICY STATEMENT Standards for Supplements to The American Journal of Managed Care All supplements to The American Journal of Managed Care are designed to facilitate and enhance ongoing medical education in various therapeutic disciplines. All Journal supplements adhere to standards of fairness and objectivity, as outlined below. Supplements to The American Journal of Managed Care will: I. Be reviewed by at least one independent expert from a recognized academic medical institution. II. Disclose the source of funding in at least one prominent place. III. Be free from editorial control exerted by personnel from the funding organization. IV. Disclose any existence of financial interests of supplement contributors to the funding organization. V. Use generic drug names only, except as needed to differentiate between therapies of similar class and indication. VI. Be up-to-date, reflecting the current (as of date of publication) standard of care. VII. Be visually distinct from The American Journal of Managed Care. VIII. Publish information that is substantially different in form and content from that of the accompanying edition of The American Journal of Managed Care. IX. Prohibit excessive remuneration for contributors and reviewers. X. Carry no advertising. Publisher s Note: The opinions expressed in this supplement are those of the authors, presenters, and/or panelists and are not attributable to the sponsor or the publisher, editor, or editorial board of The American Journal of Managed Care. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this supplement are not necessarily the same as indicated in the package insert for the product and may reflect the clinical experience of the authors, presenters, and/or panelists or may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.