Overview of the outcome trials in older patients with isolated systolic hypertension
|
|
- Alexander Jones
- 6 years ago
- Views:
Transcription
1 Journal of Human Hypertension (1999) 13, Stockton Press. All rights reserved /99 $ Overview of the outcome trials in older patients with isolated systolic hypertension JA Staessen, JG Wang, L Thijs and R Fagard Hypertensie en Cardiovasculaire Revalidatie Eenheid, Departement voor Moleculair en Cardiovasculair Onderzoek, Katholieke Universiteit Leuven, Leuven, Belgium Aims: Isolated systolic hypertension affects over 8 to 15% of all subjects older than 60 years. In the elderly, systolic hypertension is the major modifiable cardiovascular risk factor. Three placebo-controlled outcome trials on antihypertensive drug treatment of this disorder have been published. The aim of this article was to shortly review each of these three trials and to present the pooled estimates of benefit of antihypertensive drug treatment in isolated systolic hypertension in the elderly. Methods and results: The Systolic Hypertension in the Elderly Program (SHEP) in the United States, the Systolic Hypertension in Europe (Syst-Eur) trial and the Systolic Hypertension in China (Syst-China) trial published their main findings in 1991, 1997 and 1998, respectively. The outcome results of these trials were pooled by calculating the common odds ratio for active versus placebo treatment for five major end-points. Zelen s exact test for homogeneity did not reach statistical significance for any of the end-points considered. Thus, the hypothesis of a common underlying treatment effect across the three trials was not rejected. Overall, active treatment compared with placebo, reduced allcause mortality by 17%, cardiovascular mortality by 25%, all cardiovascular end-points by 32%, total stroke by 37% and myocardial infarction including sudden death by 25%. Conclusions: The pooled results of the outcome trials in older patients with isolated systolic hypertension prove that antihypertensive drug treatment must be prescribed, if on repeated measurement systolic blood pressure is 160 mm Hg or higher. Keywords: antihypertensive drug treatment; cardiovascular complications; elderly; isolated systolic hypertension; myocardial infarction; stroke Introduction Systolic blood pressure (BP) increases with age at least until the eighth decade of life. 1,2 In contrast, diastolic BP rises only until middle-age and in older subjects either levels off or even slightly decreases. These divergent trends in systolic and diastolic BP have been observed in cross-sectional 1,2 as well as in longitudinal 1 studies and explain why pulse pressure and the prevalence of isolated systolic hypertension rise with advancing age. In Western countries the latter disorder occurs in around 15% of men and women aged 60 years or more; in octagenarians its prevalence exceeds 20% (Figure 1). Isolated systolic hypertension is largely due to a decrease in the elasticity of the large arteries and is not necessarily accompanied by a rise in mean arterial BP or peripheral resistance. 3 Systolic hypertension is the most important modifiable cardiovascular risk factor in the elderly. 3 Some studies 4 suggested that the excess cardiovascular risk of hypertensive patients, compared with age-matched normotensive controls, decreases as the age of onset of high BP is more advanced. However, this point of view is contradicted by the Correspondence: Dr Jan A. Staessen, Klinisch Laboratorium Hypertensie, Inwendige Geneeskunde-Cardiologie, U.Z. Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium evidence from numerous cross-sectional and longitudinal observational studies 3 and by the results of the outcome trials in older hypertensive patients. 5 The predominance of systolic over diastolic BP as cardiovascular risk indicator in the elderly is not an artefact due to the larger range of systolic BP, because this observation still stands, if systolic and diastolic BP are expressed on a standarised scale in units of standard deviation (s.d.). Outcome trials in isolated systolic hypertension The ultimate goal of treating elderly patients with hypertension is not to reduce their BP, but to prevent the debilitating and often lethal complications of hypertension, so that survival is prolonged and quality of life improved. Three placebo-controlled outcome trials on antihypertensive drug treatment of isolated systolic hypertension have been published. 6 8 The SHEP trial The Systolic Hypertension in the Elderly Program published its primary results in ,9 A total of 4736 (1.1%) from of those screened, aged 60 years or above, were randomised to active treatment
2 860 Treatment of isolated systolic hypertension Figure 1 Prevalence of isolated systolic hypertension by the midpoint of the age classes reported in various studies. As shown by the regression line (unweighted), the prevalence of systolic hypertension rises curvilinearly with age. The 95% CI interval for the prediction of individual points is presented for the age range from 50 to 90 years. From Staessen et al 3 with permission. (n = 2365) or placebo (n = 2371). Systolic BP ranged from 160 to 219 mm Hg and diastolic BP was less than 90 mm Hg. The average BP at entry was 170 mm Hg systolic and 77 mm Hg diastolic. Age averaged 72 years. Of the participants, 57% were female, 14% were Black and 33% had previously been treated for hypertension. Before randomisation the patients were stratified by clinical centre and by antihypertensive treatment status at initial contact. Active treatment was started with the thiazide diuretic chlorthalidone ( mg per day) with the possible addition of atenolol (25 50 mg per day). In patients with known contra-indications for atenolol, the beta-blocker could be replaced by reserpine ( mg per day). Matching placebos were used in a similar fashion in the placebo group. Follow-up averaged 4.5 years. In the placebo group the 5-year systolic-diastolic BP averaged 155/72 mm Hg and in the active treatment group 143/68 mm Hg. Active treatment reduced total stroke incidence from 16.4 to 10.4 events per 1000 patient-years ( 36%; 95% confidence interval (CI): 50% to 18%; P 0.001). Drug treatment also decreased non-fatal stroke by 37% (95% CI: 18% to 51%), non-fatal myocardial infarction by 33% (95% CI: 4% to 53%), non-fatal myocardial infarction combined with coronary death by 27% (95% CI: 6% to 43%), non-fatal left ventricular failure by 54% (95% CI: 35% to 67%) and all major cardiovascular complications by 32% (95% CI: 21% to 42%). Total mortality was not significantly influenced ( 13%; 95% CI: 27% to +5%). The 5-year absolute benefit with regard to stroke and major cardiovascular endpoints amounted to 30 and 55 events per 1000 participants, 9 respectively, and was equally observed in all stratification groups 6,9 and in diabetic as well as non-diabetic patients. 10 The Syst-Eur trial In 1989, the European Working Party on High Blood Pressure in the Elderly initiated the double-blind placebo-controlled Syst-Eur (Systolic Hypertension in Europe) trial. 7,11,12 In view of the remaining uncertainties with regard to the treatment of isolated systolic hypertension in the elderly, the Syst- Eur trial continued after the publication of the SHEP results. 9 Furthermore, the recent controversy on the role of calcium channel blockers as first-line antihy- Figure 2 Reduction in the odds of total and cardiovascular mortality in three outcome trials in older patients with isolated systolic hypertension. Solid squares represent the simple odds ratios for the individual trials and triangles are the pooled odds ratios with 95% CI. Reproduced with permission from Staessen and Wang. 26
3 Treatment of isolated systolic hypertension 861 Figure 3 Reduction in the odds of fatal and non-fatal cardiovascular end-points in three outcome trials in older patients with isolated systolic hypertension. See Figure 2 for further explanation. Reproduced with permission from Staessen and Wang. 26 pertensive agents 18,19 highlighted the lack of evidence that also this newer class of drugs could reduce cardiovascular risk. As in the SHEP study, 6,9 patients eligible for enrolment in the Syst-Eur trial 7,11 were at least 60 years old. At three run-in visits 1 month apart their sitting systolic BP on single-blind placebo treatment averaged from 160 to 219 mm Hg with diastolic BP lower than 95 mm Hg. Of the participants, 67% were female and 47% had previously been treated for hypertension. 7 After stratification for centre, sex and previous cardiovascular complications, 4695 patients were randomised. Active treatment consisted of nitrendipine (10 40 mg per day) with the possible addition of enalapril (5 20 mg per day) and/or hydrochlorothiazide ( mg per day), titrated or combined to reduce the sitting systolic BP by at least 20 mm Hg to below 150 mm Hg. Matching placebo tablets were employed similarly. Patients withdrawing from double-blind treatment were followed further to facilitate an intention-to-treat analysis. 7 At 2 years (median follow-up) the sitting BP fell by 13/2 mm Hg in the placebo group (n = 2297) and by 23/7 mm Hg in the active treatment group (n = 2398). The between-group BP differences were 10.1 mm Hg systolic (95% CI: 8.8 to 11.4 mm Hg) and 4.5 mm Hg diastolic (95% CI: 3.9 to 5.1 mm Hg). Active treatment reduced the total stroke rate from 13.7 to 7.9 events per 1000 patient-years ( 42%; 95% CI: 60% to 17%; P = 0.003). Non-fatal stroke alone decreased by 44% (95% CI: 14% to 63%; P = 0.007). In the active treatment group, all fatal and non-fatal cardiac end-points, including sudden death, declined by 26% (95% CI: 3% to 44%; P = 0.03). Non-fatal cardiac end-points decreased by 33% (95% CI: 3% to 53%; P = 0.03). A similar trend was also observed for non-fatal heart failure ( 36%; 95% CI: 60% to +2%; P = 0.06), for all cases of heart failure ( 29%; 95% CI: 53% to +10%; P = 0.12) and for fatal and non-fatal myocardial infarction ( 30%; 95% CI: 56% to +9%; P = 0.12). Active treatment reduced all fatal and non-fatal cardiovascular endpoints by 31% (95% CI: 14% to 45%; P 0.001). In the analysis by intention-to-treat 7 cardiovascular mortality tended to be less on active treatment ( 27%; 95% CI: 48% to +2%; P = 0.07), but all cause mortality was not influenced ( 14%; 95% CI: 33% to +9%; P = 0.22). Treating 1000 patients for 5 years may prevent 29 strokes or 53 major cardiovascular events. In subgroup analyses, 12 active treatment was equally beneficial in all stratification groups. Furthermore, the benefit of antihypertensive drug treatment on total (P = 0.009) and cardiovascular (P = 0.09) mortality weakened with advancing age, suggesting that in very old patients ( 80 years) only non-fatal end-points were prevented. The reduction of total mortality on active treatment also decreased (P = 0.05) with lower systolic BP at entry. For fatal and non-fatal stroke the benefit of active treatment (P = 0.01) was evident only in non-smokers (92.5% of all patients). Benefit was also noticed in patients who remained on monotherapy with active nitrendipine. 20 Nitrendipine-based treatment was particularly effective in diabetic patients, in whom active
4 862 Treatment of isolated systolic hypertension treatment was estimated to prevent 178 severe cardiovascular complications as opposed to only 22 in the non-diabetic group. 21 The per-protocol analysis 12 considered only the end-points which had occurred during double-blind treatment and confirmed the results by intention-totreat. 7 However, in the per-protocol analysis, 12 active treatment also decreased total mortality by 26% (0 to 46%; P = 0.05). The per-protocol analysis suggested that treating 1000 patients for 5 years would prevent 24 deaths, or 54 major cardiovascular endpoints, or 29 strokes, or 25 cardiac end-points. The Syst-China trial Isolated systolic hypertension occurs in around 8% of Chinese people aged 60 years or older. 22 In 1988, the Systolic Hypertension in China (Syst-China) Collaborative Group started to investigate whether active treatment could reduce the incidence of stroke and other cardiovascular complications in older patients with isolated systolic hypertension. 8,22,23 All patients were initially started on placebo. After stratification for centre, sex and previous cardiovascular complications, alternate patients (n = 1253) were assigned nitrendipine mg daily, with the possible addition of captopril mg daily, or hydrochlorothiazide mg daily, or both drugs. These study medications were titrated or combined to reduce the sitting systolic BP by at least 20 mm Hg to below 150 mm Hg. In the remaining 1141 control patients, matching placebos were employed similarly. At entry sitting BP averaged 170 mm Hg systolic and 86 mm Hg diastolic. Age averaged 66.5 years and total serum cholesterol was 5.1 mmol/l. 8 At 2 years of follow-up, the sitting systolic and diastolic blood pressures had fallen by 11 mm Hg and 2 mm Hg in the placebo group and by 20 mm Hg and 5 mm Hg in the active treatment group. The betweengroup differences were 9.1 mm Hg systolic (95% CI: 7.6 to 10.7 mm Hg) and 3.2 mm Hg diastolic (95% CI: 2.4 to 4.0 mm Hg). Active treatment reduced total stroke by 38% from 20.8 to 13.0 end-points per 1000 patient-years (95% CI: 9% to 58%; P = 0.01), allcause mortality by 39% (95% CI: 16% to 57%; P = 0.003), cardiovascular mortality by 39% (95% CI: 4% to 61%; P = 0.03), stroke mortality by 58% (95% CI: 14% to 80%; P = 0.02) and all fatal and non-fatal cardiovascular end-points by 37% (95% CI: 14% to 53%; P = 0.004). Thus, antihypertensive drug treatment prevents stroke and other cardiovascular complications in older Chinese patients with isolated systolic hypertension. Treatment of 1000 Chinese patients for 5 years could prevent 55 deaths, 39 strokes, or 59 major cardiovascular endpoints. 8 A meta-analysis The results of the three outcome trials in older patients with isolated systolic hypertension were pooled, using StatXact software version 3.0 (CYTEL Software Corporation, Cambridge, MA, USA) and methods described elsewhere. 24 Zelen s exact test for homogeneity did not reach statistical significance for any of the end-points considered. Thus, the hypothesis of a common underlying treatment effect across the three studies was not rejected. Overall, compared with placebo, active treatment reduced all-cause mortality by 17% and cardiovascular mortality by 25% (Figure 2). For the fatal and non-fatal complications combined, these reductions were 32% for all cardiovascular endpoints, 37% for stroke, and 25% for myocardial infarction including sudden death (Figure 3). Conclusions The pooled results of the three outcome trials in older patients with isolated systolic hypertension prove that antihypertensive drug treatment must be prescribed, if on repeated measurement systolic BP is 160 mm Hg or higher. The entry diastolic BP level averaged nearly 85 mm Hg in the Syst-Eur 7 and Syst- China 8 trials and was as low as 77 mm Hg in the SHEP study. 9 Thus, the present findings negate the hypothesis that vigorously lowering diastolic BP would compromise the coronary circulation and provoke rather than prevent coronary complications. 25 The evidence from the intervention trials 26 also supports the recent recommendations of the National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. This expert committee considered isolated systolic hypertension in the elderly as a compelling indication for the use of thiazide diuretics or long-acting dihydropyrides as first-line antihypertensive drugs. 27 References 1 Kannel WB, Gordon T. Evaluation of cardiovacular risk in the elderly: the Framingham study. Bull NY Acad Med 1978; 54: Staessen J et al. The increase in blood pressure with age and body mass index is overestimated by conventional sphygmomanometry. Am J Epidemiol 1992; 136: Staessen J, Amery A, Fagard R. Editorial review. Isolated systolic hypertension in the elderly. J Hypertens 1990; 8: Buck C, Baker P, Bass M, Donner A. The prognosis of hypertension according to age at onset. Hypertension 1987; 9: Thijs L et al. Why is antihypertensive drug therapy needed in elderly patients with systolodiastolic hypertension? J Hypertens 1994; 12 (Suppl 6): S25 S34. 6 The Systolic Hypertension in the Elderly Program Cooperative Research Group. Implications of the Systolic Hypertension in the Elderly Program. Hypertension 1993; 21: Staessen JA et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension [correction published in Lancet 1997, volume 350, November 29, p 1636]. Lancet 1997; 350: Liu L et al for the Systolic Hypertension in China (Syst-China) Collaborative Group. Comparison of active treatment and placebo for older Chinese patients with isolated systolic hypertension. J Hypertens 1998; 16: SHEP Cooperative Research Group. Prevention of
5 Treatment of isolated systolic hypertension stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265: Curb JD et al. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. JAMA 1996; 276: Amery A et al. Syst-Eur. A multicentre trial on the treatment of isolated systolic hypertension in the elderly: objectives, protocol, and organization. Aging Clin Exp Res 1991; 3: Staessen JA et al. Subgroup and per-protocol analysis of the randomized European trial on isolated systolic hypertension in the elderly. Arch Intern Med 1998; 158: Fletcher A et al. Implications for trials in progress of publication of positive results. Lancet 1993; 342: Kaplan NM. Systolic Hypertension in the Elderly Program (SHEP) and Swedish Trial in Old Patients With Hypertension (STOP). The promises and the potential problems. Am J Hypertens 1992; 5: Ménard J, Day M, Chatellier G, Laragh JH. Some lessons from Systolic Hypertension in the Elderly Program (SHEP). Am J Hypertens 1992; 5: Staessen J, Fagard R, Amery A. Isolated systolic hypertension in the elderly: implications of SHEP for clinical practice and for the ongoing trials. J Hum Hypertens 1991; 5: Staessen JA, Amery A, Birkenhäger W. Inverse association between baseline pressure and benefit from treatment in isolated systolic hypertension. Hypertension 1994; 23: Furberg CD, Psaty BM, Meyer JV. Nifedipine. Doserelated increase in mortality in patients with coronary heart disease. Circulation 1995; 92: Psaty BM et al. The risk of myocardial infarction associated with antihypertensive drug therapies. JAMA 1995; 274: Staessen JA et al. Calcium channel blockade and cardiovascular prognosis in the European trial on isolated systolic hypertension. Hypertension 1998; 32: Tuomilehto J et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. 1999; 340: Collaborative Group Coordinating Center. Systolic hypertension in the elderly: Chinese trial (Syst- China) Interim report. Chin J Cardiol 1992; 20: Wang J et al. Long-term blood pressure control in older Chinese patients with isolated systolic hypertension: a progress report on the Syst-China trial. J Hum Hypertens 1996; 10: Thijs L et al. A meta-analysis of outcome trials in elderly hypertensives. J Hypertens 1992; 10: Cruickshank JM, Thorp JM, Zacharias FJ. Benefits and potential harm of lowering high blood pressure. Lancet 1987; i: Staessen JA, Wang JG. Benefit of antihypertensive drug treatment in older patients with isolated systolic hypertension. Eur Heart J Suppl 1999; 1 (Suppl 2): (in press). 27 The Joint National Committee on Prevention Detection Evaluation and Treatment of High Blood Pressure. The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157:
Large therapeutic studies in elderly patients with hypertension
(2002) 16 (Suppl 1), S38 S43 2002 Nature Publishing Group All rights reserved 0950-9240/02 $25.00 www.nature.com/jhh Large therapeutic studies in elderly patients with hypertension Centro Clinico Profesional
More informationPulse Pressure Not Mean Pressure Determines Cardiovascular Risk in Older Hypertensive Patients
ORIGINAL INVESTIGATION Pulse Pressure Not Mean Pressure Determines Cardiovascular Risk in Older Hypertensive Patients Jacques Blacher, MD; Jan A. Staessen, MD, PhD; Xavier Girerd, MD; Jerzy Gasowski, MD;
More informationThe problem of uncontrolled hypertension
(2002) 16, S3 S8 2002 Nature Publishing Group All rights reserved 0950-9240/02 $25.00 www.nature.com/jhh The problem of uncontrolled hypertension Department of Public Health and Clinical Medicine, Norrlands
More informationHypertension in the Elderly. John Puxty Division of Geriatrics Center for Studies in Aging and Health, Providence Care
Hypertension in the Elderly John Puxty Division of Geriatrics Center for Studies in Aging and Health, Providence Care Learning Objectives Review evidence for treatment of hypertension in elderly Consider
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 informationReceived 23 March 2003 Revised 6 April 2003 Accepted 9 April 2003
Original article 1055 Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1 March 2003 Jan A. Staessen, Ji-Guang Wang and Lutgarde Thijs Background In a meta-analysis
More informationImproving Medical Statistics and Interpretation of Clinical Trials
Improving Medical Statistics and Interpretation of Clinical Trials 1 ALLHAT Trial & ALLHAT Meta-Analysis Critique Table of Contents ALLHAT Trial Critique- Overview p 2-4 Critique Of The Flawed Meta-Analysis
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 informationPrognostic significance of blood pressure measured in the office, at home and during ambulatory monitoring in older patients in general practice
(2005) 19, 801 807 & 2005 Nature Publishing Group All rights reserved 0950-9240/05 $30.00 www.nature.com/jhh ORIGINAL ARTICLE Prognostic significance of blood pressure measured in the office, at home and
More informationIncident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial [HYVET] R. Peters
Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial [HYVET] R. Peters ClinicalTrials.gov: NCT00122811 Backgound The prevalence of dementia rises with increasing
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 informationSlide notes: References:
1 2 3 Cut-off values for the definition of hypertension are systolic blood pressure (SBP) 135 and/or diastolic blood pressure (DBP) 85 mmhg for home blood pressure monitoring (HBPM) and daytime ambulatory
More informationPreventing the cardiovascular complications of hypertension
European Heart Journal Supplements (2004) 6 (Supplement H), H37 H42 Preventing the cardiovascular complications of hypertension Peter Trenkwalder* Department of Internal Medicine, Starnberg Hospital, Ludwig
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 informationIsolated Systolic Hypertension in the elderly. Daniel Hayoz Clinique de Médecine Interne HFR-Hôpital Cantonal Fribourg
Isolated Systolic Hypertension in the elderly Daniel Hayoz Clinique de Médecine Interne HFR-Hôpital Cantonal Fribourg Case no 1 Man aged 75, from Kosovo, in CH since 1.5 years Former smoker (45 PY) BP:
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 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 informationShould beta blockers remain first-line drugs for hypertension?
1 de 6 03/11/2008 13:23 Should beta blockers remain first-line drugs for hypertension? Maros Elsik, Cardiologist, Department of Epidemiology and Preventive Medicine, Monash University and The Alfred Hospital,
More informationAntihypertensive efficacy of olmesartan compared with other antihypertensive drugs
(2002) 16 (Suppl 2), S24 S28 2002 Nature Publishing Group All rights reserved 0950-9240/02 $25.00 www.nature.com/jhh compared with other antihypertensive drugs University Clinic Bonn, Department of Internal
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 information47 Hypertension in Elderly
47 Hypertension in Elderly YOU DO NOT HEAL OLD AGE; YOU PROTECT IT; YOU PROMOTE IT; YOU EXTEND IT Sir James Sterling Ross Abstract: The prevalence of hypertension rises with age and the complications secondary
More informationSystolic Hypertension in the Elderly: Addressing an Unmet Need
REVIEW Systolic Hypertension in the Elderly: Addressing an Unmet Need Daniel A. Duprez, MD, PhD Cardiovascular Division, Medical School, University of Minnesota, Minn. ABSTRACT Systolic hypertension is
More informationORIGINAL ARTICLES. Design. Randomised, placebo-controlled, double-blind outcome trial.
DIHYDROPYRIDINE CALCIUM CHANNEL BLOCKERS FOR ANTIHYPERTENSIVE TREATMENT IN OLDER PATIENTS - FROM THE SYSTOLIC EVIDENCE HYPERTENSION IN. EUROPE TRIAL Jan A Staessen, Lutgarde Thijs, Hilde Celis, Jerzy Gasowski,
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 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 in the elderly
091 Hypertension in the elderly Hypertension remains widely prevalent and a significant determinant of cardiovascular risk in the elderly population. Several large controlled trials have shown the benefits
More informationHYPERTENSION IN ME EUIERLY HYPERTENSION AM) CARDIOVASCULAR RISK VALUE OF TREATMENT
HYPERTENSION IN ME EUIERLY K. O'Malley, M. S. Laher, E. T. O'Brien Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, and Hypertension Evaluation and Treatment Clinic, The Charitable
More informationJournal of Hypertension 2004, 22: a Hypertension and Cardiovascular Rehabilitation Unit, Catholic University of
Original article 81 Relationship between ambulatory blood pressure and followup clinic blood pressure in elderly patients with systolic hypertension Robert H. Fagard a, Jan A. Staessen a, Lutgarde Thijs
More informationAbbreviations Cardiology I
Cardiology I and Clinical Controversies Joseph J. Saseen, Pharm.D., FCCP, BCPS (AQ Cardiology) Reviewed by Stuart T. Haines, Pharm.D., FCCP, BCPS; and Michelle M. Richardson, Pharm.D., FCCP, BCPS Learning
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 informationBy Prof. Khaled El-Rabat
What is The Optimum? By Prof. Khaled El-Rabat Professor of Cardiology - Benha Faculty of Medicine HT. Introduction Despite major worldwide efforts over recent decades directed at diagnosing and treating
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 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 informationThe CARI Guidelines Caring for Australasians with Renal Impairment. Blood Pressure Control role of specific antihypertensives
Blood Pressure Control role of specific antihypertensives Date written: May 2005 Final submission: October 2005 Author: Adrian Gillian GUIDELINES a. Regimens that include angiotensin-converting enzyme
More informationApparent effect on blood pressure is only partly responsible for the risk reduction due to antihypertensive treatments
ORIGINAL ARTICLE doi: 10.1111/j.1472-8206.2005.00356.x Apparent effect on blood pressure is only partly responsible for the risk reduction due to antihypertensive treatments Jean-Pierre Boissel a *, François
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 informationORIGINAL INVESTIGATION. Calcium Antagonists and Mortality Risk in Men and Women With Hypertension in the Framingham Heart Study
ORIGINAL INVESTIGATION s and Mortality Risk in Men and Women With Hypertension in the Framingham Heart Study Vivian M. Abascal, MD; Martin G. Larson, ScD; Jane C. Evans, MPH; Ana T. Blohm, BA; Kim Poli,
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 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 informationCerebral involvement in hypertensive cardiovascular disease
European Heart Journal Supplements (2003) 5 (Supplement F), F19 F25 Cerebral involvement in hypertensive cardiovascular disease Hypertension Unit, Hospital Clinic (IDIBAPS), University of Barcelona, Barcelona,
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 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 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 informationShort-term antihypertensive efficacy of perindopril according to clinical profile of 3,188 patients: A meta-analysis
ORIGINAL ARTICLE Cardiology Journal 2010, Vol. 17, No. X, pp. 1 XX Copyright 2010 Via Medica ISSN 1897 5593 Short-term antihypertensive efficacy of perindopril according to clinical profile of 3,188 patients:
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 informationAwareness of and therapy for hypertension in the United States have been increasing in
Hypertension in the Elderly Can We Improve Results of Therapy? L. Michael Prisant, MD; Marvin Moser, MD REVIEW ARTICLE Awareness of and therapy for hypertension in the United States have been increasing
More informationORIGINAL INVESTIGATION. Antihypertensive Drug Therapies and the Risk of Ischemic Stroke
ORIGINAL INVESTIGATION Antihypertensive Drug Therapies and the Risk of Ischemic Stroke Olaf H. Klungel, PharmD, PhD; Susan R. Heckbert, MD, PhD; W. T. Longstreth, Jr, MD, MPH; Curt D. Furberg, MD, PhD;
More informationDrug treatments in hypertension outcome studies
The Second Australian National Blood Pressure Study Page 1 of 6 Background Outcome of treatment of hypertension Over the past 25 years studies of the drug treatment of mild-moderate hypertension have demonstrated
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 informationCombination therapy Giuseppe M.C. Rosano, MD, PhD, MSc, FESC, FHFA St George s Hospitals NHS Trust University of London
Combination therapy Giuseppe M.C. Rosano, MD, PhD, MSc, FESC, FHFA St George s Hospitals NHS Trust University of London KCS Congress: Impact through collaboration CONTACT: Tel. +254 735 833 803 Email:
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 in Adults Across the Age Spectrum
ORIGINAL CONTRIBUTION Hypertension in Adults Across the Age Spectrum Current Outcomes and Control in the Community Donald M. Lloyd-Jones, MD, ScM Jane C. Evans, DSc Daniel Levy, MD ELDERLY PERSONS ARE
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 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 informationManagement of Hypertension
Clinical Practice Guidelines Management of Hypertension Definition and classification of blood pressure levels (mmhg) Category Systolic Diastolic Normal
More informationMetoprolol Succinate SelokenZOC
Metoprolol Succinate SelokenZOC Blood Pressure Control and Far Beyond Mohamed Abdel Ghany World Health Organization - Noncommunicable Diseases (NCD) Country Profiles, 2014. 1 Death Rates From Ischemic
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 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 informationANTIHYPERTENSIVE DRUGS USED BY HYPERTENSIVE PATIENTS IN THE PROVINCIAL CITIES OF ISFAHAN, NAJAFABAD AND ARAK
ANTIHYPERTENSIVE DRUGS USED BY HYPERTENSIVE PATIENTS IN THE PROVINCIAL CITIES OF ISFAHAN, NAJAFABAD AND ARAK Keywords Hypertension Adults Antihypertensive drugs Combinational regimens ARYA Journal, 2006,
More informationCopyright Larry FatNews.com, All Rights Reserved. Thursday, June 18, 2009
[A statement made in a editorial about the blood pressure drug Cozaar (losartan)] is disturbing.... The authors seemingly want us to believe... [this] deceptive statement. Franz Messerli, MD, European
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 informationHigh-dose monotherapy vs low-dose combination therapy of calcium channel blockers and angiotensin receptor blockers in mild to moderate hypertension
(2005) 19, 491 496 & 2005 Nature Publishing Group All rights reserved 0950-9240/05 $30.00 www.nature.com/jhh ORIGINAL ARTICLE High-dose monotherapy vs low-dose combination therapy of calcium channel blockers
More informationDRUG UTILIZATION PATTERNS OF ANTIHYPERTENSIVES IN VARIOUS WARDS IN A TERTIARY CARE HOSPITAL IN TAMILNADU
Original Article DRUG UTILIZATION PATTERNS OF ANTIHYPERTENSIVES IN VARIOUS WARDS IN A TERTIARY CARE HOSPITAL IN TAMILNADU V.Gowri 1, K.Punnagai, K.Vijaybabu 3, Dr.Darling Chellathai 4 1 Assistant Professor
More informationRisk Factors for Ischemic Stroke: Electrocardiographic Findings
Original Articles 232 Risk Factors for Ischemic Stroke: Electrocardiographic Findings Elley H.H. Chiu 1,2, Teng-Yeow Tan 1,3, Ku-Chou Chang 1,3, and Chia-Wei Liou 1,3 Abstract- Background: Standard 12-lead
More informationMetformin should be considered in all patients with type 2 diabetes unless contra-indicated
November 2001 N P S National Prescribing Service Limited PPR fifteen Prescribing Practice Review PPR Managing type 2 diabetes For General Practice Key messages Metformin should be considered in all patients
More informationReducing proteinuria
Date written: May 2005 Final submission: October 2005 Author: Adrian Gillin Reducing proteinuria GUIDELINES a. The beneficial effect of treatment regimens that include angiotensinconverting enzyme inhibitors
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 informationORIGINAL INVESTIGATION
ORIGINAL INVESTIGATION Influence of Long-term, Low-Dose, Diuretic-Based, Antihypertensive Therapy on Glucose, Lipid, Uric Acid, and Potassium Levels in Older Men and Women With Isolated Systolic Hypertension
More informationLowering blood pressure in 2003
UPDATE CLINICAL UPDATE Lowering blood pressure in 2003 John P Chalmers and Leonard F Arnolda Institute for International Health, University of Sydney, Sydney, NSW. John P Chalmers, MD, FRACP, Professor
More informationType of intervention Primary prevention; secondary prevention. Economic study type Cost-effectiveness analysis and cost utility analysis.
A predictive model of the health benefits and cost effectiveness of celiprolol and atenolol in primary prevention of cardiovascular disease in hypertensive patients Milne R J, Hoorn S V, Jackson R T Record
More informationBlood Pressure Lowering Efficacy of Perindopril/ Indapamide Fixed Dose Combination in Uncontrolled Hypertension
525 Blood Pressure Lowering Efficacy of Perindopril/ Indapamide Fixed Dose Combination in Uncontrolled Hypertension PHIMDA Kriangsak 1* and CHOTNOPARATPAT Paiboon 2 1 Diabetes and Hypertension Clinic,
More informationThe prevalence of hypertension in a representative
CLINICAL STRATEGIES FOR OPTIMAL HYPERTENSION MANAGEMENT Roger S. Blumenthal, MD * ABSTRACT In the United States, approximately 25% of the adult population older than 40 years has hypertension. Americans
More informationEfficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis
Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis Dipak Kotecha, MD PhD on behalf of the Selection of slides presented at the European
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 informationClinical cases with Coversyl 10 mg
Clinical cases Coversyl 10 mg For upgraded benefits in hypertension A Editorial This brochure, Clinical cases Coversyl 10 mg for upgraded benefits in hypertension, illustrates a variety of hypertensive
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 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 informationExecutive Summary. Different antihypertensive drugs as first line therapy in patients with essential hypertension 1
IQWiG Reports Commission No. A05-09 Different antihypertensive drugs as first line therapy in patients with essential hypertension 1 Executive Summary 1 Translation of the executive summary of the final
More informationPrevalence, awareness, treatment and control of hypertension in the elderly: results from a population survey
(2000) 14, 825 830 2000 Macmillan Publishers Ltd All rights reserved 0950-9240/00 $15.00 www.nature.com/jhh ORIGINAL ARTICLE Prevalence, awareness, treatment and control of hypertension in the elderly:
More informationANTIHYPERTENSIVE DRUG THERAPY IN CONSIDERATION OF CIRCADIAN BLOOD PRESSURE VARIATION*
Progress in Clinical Medicine 1 ANTIHYPERTENSIVE DRUG THERAPY IN CONSIDERATION OF CIRCADIAN BLOOD PRESSURE VARIATION* Keishi ABE** Asian Med. J. 44(2): 83 90, 2001 Abstract: J-MUBA was a large-scale clinical
More informationTodd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM
Todd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM Faculty Disclosure I have no financial interest to disclose No off-label use of medications will be discussed FIFTH ANNUAL SYMPOSIUM Recognize changes between
More informationRole of Clopidogrel in Acute Coronary Syndromes. Hossam Kandil,, MD. Professor of Cardiology Cairo University
Role of Clopidogrel in Acute Coronary Syndromes Hossam Kandil,, MD Professor of Cardiology Cairo University ACS Treatment Strategies Reperfusion/Revascularization Therapy Thrombolysis PCI (with/ without
More informationHypertension is a major risk factor for
OPTIMAL RISK MANAGEMENT OF THE HYPERTENSIVE PATIENT WITH MULTIPLE RISK FACTORS * Keith C. Ferdinand, MD, FACC ABSTRACT To determine the risk of cardiovascular disease in patients with hypertension, it
More informationNotes Indicate to the group that this patient will be the focus of today s case discussion.
1 Indicate to the group that this patient will be the focus of today s case discussion. Read out the case authors and their disclosure information. Instructions Fill out prior to the meeting and disclose
More informationJournal of the American College of Cardiology Vol. 44, No. 6, by the American College of Cardiology Foundation ISSN /04/$30.
Journal of the American College of Cardiology Vol. 44, No. 6, 2004 2004 by the American College of Cardiology Foundation ISSN 0735-1097/04/$30.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2004.06.034
More informationEvidence Supporting Post-MI Use of
Addressing the Gap in the Management of Patients After Acute Myocardial Infarction: How Good Is the Evidence Supporting Current Treatment Guidelines? Michael B. Fowler, MB, FRCP Beta-adrenergic blocking
More informationWhen should blood pressure be lowered? Should treatment be guided by blood pressure values or total cardiovascular risk?
OF JOURNAL HYPERTENSION JH R RESEARCH Journal of HYPERTENSION RESEARCH www.hypertens.org/jhr Editorial J Hypertens Res (2016) 2(2):47 51 When should blood pressure be lowered? Should treatment be guided
More informationAmbulatory blood pressure (ABP) may be normal in
Response to Antihypertensive Therapy in Older Patients With Sustained and Nonsustained Systolic Hypertension Robert H. Fagard, MD; Jan A. Staessen, MD; Lutgarde Thijs, BSc; Jerzy Gasowski, MD; Christopher
More informationDr. Khan Abul Kalam Azad Associate Professor Department of Medicine SZRMC, Bogra
Dr. Khan Abul Kalam Azad Associate Professor Department of Medicine SZRMC, Bogra Beta-blockers were used in several longterm morbidity and trials in the treatment of hypertension, either alone or in comparison
More informationHypertension and diabetic nephropathy
Hypertension and diabetic nephropathy Elisabeth R. Mathiesen Professor, Chief Physician, Dr sci Dep. Of Endocrinology Rigshospitalet, University of Copenhagen Denmark Hypertension Brain Eye Heart Kidney
More informationYuqing Zhang, M.D., FESC Department of Cardiology, Fu Wai Hospital. CAMS & PUMC, Beijing, China
What Can We Learn from the Observational Studies and Clinical Trials of Prehypertension? Yuqing Zhang, M.D., FESC Department of Cardiology, Fu Wai Hospital. CAMS & PUMC, Beijing, China At ARIC visit 4
More informationBRIEF COMMUNICATIONS. KEY WORDS: Ambulatory blood pressure monitoring, placebo effect, antihypertensive drug trials.
AJH 1995; 8:311-315 BRIEF COMMUNICATIONS Lack of Placebo Effect on Ambulatory Blood Pressure Giuseppe Mancia, Stefano Omboni, Gianfranco Parati, Antonella Ravogli, Alessandra Villani, and Alberto Zanchetti
More information9/17/2015. Reference: Ruschitzka F. J Hypertens 2011;29(Suppl 1):S9-14.
0 1 2 Reference: Ruschitzka F. J Hypertens 2011;29(Suppl 1):S9-14. 3 Slide notes: Large trials such as ALLHAT, LIFE and ASCOT show that the majority of patients with hypertension will require multiple
More informationThe hypertensive effects of the renin-angiotensin
Comparison of Telmisartan vs. Valsartan in the Treatment of Mild to Moderate Hypertension Using Ambulatory Blood Pressure Monitoring George Bakris, MD A prospective, randomized, open-label, blinded end-point
More informationNew approaches to the uses of beta blocking drugs in hypertension
(2000) 14, Suppl 1, S63 S68 2000 Macmillan Publishers Ltd All rights reserved 0950-9240/00 $15.00 www.nature.com/jhh New approaches to the uses of beta blocking drugs in hypertension BNC Prichard 1, BR
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 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 information