Hypertensive Crises. Controlling high blood pressure prevents disease. Recognition and Management of Acute Hypertensive Emergencies
|
|
- Sophie Townsend
- 6 years ago
- Views:
Transcription
1 Controlling high blood pressure prevents disease Recognition and Management of Acute Hypertensive Emergencies David idweiner, M.D. Co-holder, C. Craig and Audrae Tisher Chair in Nephrology Functional Genomics University of Florida College of Medicine and NF/SGVHS Arch Int Med 157:2413, Those at greatest risk benefit the most JNC-7 BP Classifications Classification SBP DBP Normal < 120 <80 Prehypertension Stage I Stage II Hypertensive crisis > 180 >120 Arch Int Med 157:2413, Two types of hypertensive crisis Long-term survival is bad in patients with hypertensive emergency Hypertensive emergency Hypertension causing acute end-organ damage Hypertensive urgency Hypertension not causing acute end-organ damage, (Typically y causes severe anxiety, particularly in the physicians) Predictors of shorter survival Renal damage Proteinuria BUN > 28 mg/dl Creatinine > 2.2 mg/dl LVH by ECG Causes of death Renal failure (39.7%), Stroke (23.8%), Myocardial infarction (11.1%) Heart failure (10.3%) Median Survival (Months) J Hypertens 13:915-24, University of Florida College of Medicine Page 1
2 Patients with hypertensive emergencies have hypertension-related and other chronic conditions Antihypertensive use in week prior to presentation 90% 82% 80% 70% 60% 50% 40% 60% 50% 40% 30% 46% 54% 32% 31% 24% 22% 30% 20% 19% 17% 10% 0% 10% 9% 15% 16% 20% 20% 15% 12% 10% 0% 2% 2% Acad Emerg Med 7:653-62, Acad Emerg Med 7:653-62, Hypertensive Emergency What are the typical presentations? What should you do - JNC-7 Guidelines Acute pulmonary edema, 37% Intracerebral or SAH, 5% Encephalopathy, 16% ACS, 12% Aortic dissection, 2% Eclampsia, 5% Ischemic CVA, 25% The initial goal of therapy in hypertensive emergencies is to Reduce mean arterial BP by no more than 25% within the first hour, Then, if stable, To 160/ mmhg within the next 2-6 hours. But, which is worse Risk of ACUTE hypertension-induced tissue damage Risk of ACUTELY decreased tissue perfusion due to decreased BP How solid is the data for these recommendations? In depth Cochrane review, It was definitively disappointing No RCT evidence to answer the question: Does antihypertensive therapy, as compared to placebo or no treatment, Change mortality and morbidity in patients with hypertensive emergencies? Patient #1 Mr. XYZ is a 72 yo gentleman who presents to the ED with acute onset of left arm weakness 4 hours earlier. The event occurred while he was putting on the 15 th hole, he missed his putt, and he complains about missing the putt. He tells you he has a h/o HTN and DM and that his HTN is treated with a β-blocker and an ACE-I. He took his β-blocker this morning (to help his putting!). He did not take his ACE-I (he worries about getting lightheaded while playing golf on a hot day) J Hum Hypertens 22: , University of Florida College of Medicine Page 2
3 Patient #1 Physical examination BP 187/121; HR 84; RR 20 (wnl) Left arm weakness, with increased DTR in the biceps Is this a hypertensive emergency? Yes, very hypertensive Yes, has acute end-organ damage Should you Lower the BP? Raise the BP? Hypertensive emergency in the setting of an acute CVA Elevated BP, in the short-term, may maintain ischemic tissue perfusion BP decreases ~20 mmhg in first 24 hr in the absence of therapy JD Blumenfeld, et al, AJH 14: , Correlation between BP and outcome in stroke patients Excessive BP change (1st 24 hrs) worsens outcome 90% 100% 57% 80% 54% 30% 60% 49% 13% 24% 40% Increase 20% 14% 11% Decrease >20 Decrease % SBP change in 1 st Early neurologic Poor neurologic Mortality, 3 deterioration outcome month 24 hours Stroke 33: , J Castillo, et al, Stroke 35:520-7, Clinical trials of BP management in acute stroke Effect of early candesartan on events after CVA Calcium channel blockers Ineffective Cochrane Database of Systematic Reviews 2000; Issue 1. Outcome worsened Cerebrovascular Diseases 1994;4: Stroke 2000;31: β-receptor antagonists Outcome worsened BMJ 1988;296: Lisinopril or labetalol vs placebo Decreased mortality, but no effect on functional status Lancet 2009;8: ARB s No effect on functional outcome at 3 months, but improved mortality and vascular events at 10 months Stroke 2003;34: No improvement in any measure at t6 months, and dincreased risk of poor functional outcome with ARB use Lancet 377:741-50, Trial of stopping meds! No difference between stopping or continuing meds on outcomes Lancet Neurol 2010; 9:62-5. Lancet 377:741-50, 2011 University of Florida College of Medicine Page 3
4 Effect of early candesartan on events after CVA Recent (2011) editorial The results of the 2011 ARB trial are also consistent with the results of ten previous trials of blood-pressurelowering drugs in independent populations with acute stroke. Clinicians should therefore not be prescribing blood- pressure-lowering drugs with the first week of acute stroke in routine practice. Lancet 377:741-50, 2011 Lancet 377:696-8, Stroke and hypertension summary BP > 185/110 Yes Bring it down some (Labetalol, Nicardipine); Keep it down Yes No Reperfusion Therapy? Take a deep breath, Relax. No need for emergent therapy No Yes Bring it down slowly % in 1 st day BP > 220/120 No Take a deep breath, Relax What to do in the setting of an acute ischemic CVA Patient is eligible for acute reperfusion intervention SDP > 185 or DBP > 110 Labetalol 10 to 20 mg IV over 1 to 2 minutes, may repeat once; or Nitropaste 1 to 2 inches; or Nicardipine infusion 5 mg/h, titrate up by 2.5 mg/h at 5- to 15-minute intervals, maximum dose 15 mg/h; when desired blood pressure attained, reduce to 3 mg/h If blood pressure does not decline and remains >185/110 mm Hg, do not administer thrombolytics BP management pressure during and after treatment acute reperfusion Monitor blood pressure every 15 minutes during treatment and then for another 2 hours, then every 30 minutes for 6 hours, and then every hour for 16 hours Systolic 180 to 230 mm Hg or diastolic 105 to 120 mm Hg Labetalol 10 mg IV over 1 to 2 minutes, may repeat every 10 to 20 minutes, maximum dose of 300 mg; or Labetalol 10 mg IV followed by an infusion at 2 to 8 mg/min Systolic 230 mm Hg or diastolic 121 to 140 mm Hg Labetalol 10 mg IV over 1 to 2 minutes, may repeat every 10 to 20 minutes, maximum dose of 300 mg; or Labetalol 10 mg IV followed by an infusion at 2 to 8 mg/min; or Nicardipine infusion, 5 mg/h, titrate up to desired effect by increasing 2.5 mg/h every 5 minutes to maximum of 15 mg/h If blood pressure not controlled, consider sodium nitroprusside BP management if no reperfusion therapy SBP 220 and DBP 120 Relax, take a deep breath and do nothing Continue existing meds SBP > 220 or DBP > 120 Lower BP cautiously Reasonable goal 15-25% within the first day Restart oral medications, titrate carefully my recommendations University of Florida College of Medicine Page 4
5 Patient #2 Mrs. ABC is the 69 yo wife of Mr. XYZ who, on the same day, while playing tennis had acute onset of precordial tightness, diaphoresis and shortness of breath. She has a h/o HTN and DM; her HTN is treated with a β- blocker and an ACE-I I. She did not take either her β-blocker or ACE-I this morning (she worries about getting light-headed while playing tennis) Patient #2 EKG reveals acute ST-T wave changes Troponin is elevated BP 187/121; HR 84; RR 20 (wnl) What should you do about her BP? Hypertensive emergency and ACS Patient #3 Elevated BP increases myocardial O 2 demand Treatment goal Decrease myocardial O 2 demand while increasing O 2 delivery β-blockers Labetalol Nitroglycerin Avoid Nitroprusside Coronary steal Enalaprilat Unpredictable effect on BP Nicardipine Reflex tachycardia and increased myocardial O 2 demand Mr. DEF, their 45 yo son has worsening dyspnea for four days. He has non-ischemic cardiomyopathy, EF 15%. Because of work pressure, he has been drinking large amounts of coffee, using Adderal for ADHD and has not been taking his β-blocker, ACE-I and diuretic (they make him tired). BP 187/121; HR 84; RR 20 (wnl) Hypertensive emergency and CHF Patient #4 Hypertension increases afterload Decreases cardiac output Increases pre-load Causes development of pulmonary edema Treatment goal decrease afterload and preload Nitroprusside Needs arterial line ACE-I IV enalaprilat Avoid Nicardipine Reflex tachycardia, may decrease myocardial contractility Hydralazine Increased cardiac work β-blockers Decreased myocardial contractility Mrs. HIJ, their 44 yo daughter, on the same day, comes in with acute onset of back pain. She has Marfan s syndrome. Physical examination reveals 187/121; HR 84; RR 20 (wnl) BP in legs is 102/72 University of Florida College of Medicine Page 5
6 Aortic dissection and hypertension Critical to reduce both BP and dp/dt β-blocker, must be initial therapy (reduces both) Labetalol Metoprolol Esmolol Large volume load ( ml/kg/hr) Vasodilator, if needed, to reduce BP Nitroprusside Patient #5 Ms. KLM is the 24 yo granddaughter who, on the same day, while visiting her family, gets her BP checked and is found to have a BP of 187/121. She has a long-history of SLE Laboratory studies: BUN/Cr; 47/2.38 Hgb, 10.2 Haptoglobin, <10 Platelets, 47K Hypertensive emergency and renal involvement Labetalol Nicardipine Fenoldopam Nitroprusside Short-term only, < 48 hr! Patient #6 Mr. NOP is Mrs. ABC s brother While visiting her in the hospital, he has his VS checked 187/121; HR 84; RR 20 (wnl) He has a history of HTN and DM He did not take either his ACE-I or β-blocker today because he was hurrying to come visit her Physical exam, screening laboratory studies (renal function panel, CBC, U/A) All unremarkable What should you do? Differentiate hypertensive urgency from hypertensive emergency Is there acute end-organ damage? If not, then hypertensive urgency Does NOT require, or even need in most cases, hospital admission Key to treatment: This is a long-term problem, not a short-term problem Take a deep breath and relax Headache and anxiety are NOT end-organ damage Treating hypertensive urgency Restart meds, if discontinued or not current Add a new medication or increase dose of existing medication Arrange out-patient follow-up, preferably in 1-2 days Avoid clonidine! University of Florida College of Medicine Page 6
7 My favorite meds for hypertensive emergency Drug Dose Onset Duration Special indications Nitroprusside µg/kg/min Immediate 1-2 min Need arterial line; 48 hr limit with renal failure Nicardipine 5 mg/hr, titrate up by 5-10 min Caution with CAD 2.5 mg/h at 5- to 15- minute intervals, to max 15 min, but can be >4 hr Labetalol mg IV q 10 min mg/min 5-10 min 3-6 hr Avoid with CHF Enalaprilat mg q6hr min 6-12 hr Avoid with ACS, response variable depending on level of renin NTG µg/min 2-5 min 5-10 min Useful with ACS My less favorite meds for hypertensive emergency Drug Dose Onset Duration Special indications Fenoldopam < 5 min 30 min µg/kg/min Hydralazine mg IV min 1-4 hr Eclampsia mg IM min 4-6 hr Esmolol min min Aortic dissection µg/kg/min / Phentolamine 5-15 mg IV 1-2 min min Pheochromocytoma University of Florida College of Medicine Page 7
Hypertensives Emergency and Urgency
Hypertensives Emergency and Urgency Budi Yuli Setianto Cardiology Divisision Department of Internal Medicine Faculty of Medicine UGM Sardjito Hospital Yogyakarta Background USA: Hypertension is 30% of
More informationHypertensive Urgency and Emergency. Definitions. Emergency or Urgency?
Hypertensive Urgency and Emergency Joel Handler MD Kaiser Permanente Care Management Institute/ SCal Region Hypertension Lead Definitions Hypertensive Emergency: -Severe elevation in BP with evidence of
More informationHYPERTENSION IN EMERGENCY MEDICINE Michael Jay Bresler, M.D., FACEP
HYPERTENSION IN EMERGENCY MEDICINE Michael Jay Bresler, M.D., FACEP What is normal blood pressure? Prehypertension 130-139/80-90 Compared with normal BP Double the risk for developing hypertension. Lifestyle
More informationManagement of Hypertension. Ahmed El Hawary MD Suez Canal University
Management of Hypertension Ahmed El Hawary MD Suez Canal University Minimal vs. Optimal Care Resources more than science affect type of care and level of management. what is possible (minimal care) and
More informationBlood Pressure Management in Acute Ischemic Stroke
Blood Pressure Management in Acute Ischemic Stroke Kimberly Clark, PharmD, BCCCP Clinical Pharmacy Specialist Critical Care, Greenville Health System Adjunct Assistant Professor, South Carolina College
More informationProtocol for IV rtpa Treatment of Acute Ischemic Stroke
Protocol for IV rtpa Treatment of Acute Ischemic Stroke Acute stroke management is progressing very rapidly. Our team offers several options for acute stroke therapy, including endovascular therapy and
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 informationIntroductory Clinical Pharmacology Chapter 41 Antihypertensive Drugs
Introductory Clinical Pharmacology Chapter 41 Antihypertensive Drugs Blood Pressure Normal = sys
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 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 informationBLOOD PRESSURE MANAGEMENT IN THE ACUTE PHASE
BLOOD PRESSURE MANAGEMENT IN THE ACUTE PHASE Ελένη Κορομπόκη, MD, PhD, FESO Α Νευρολογική Κλινική, ΕΚΠΑ, Αιγινήτειο Νοσοκομείο Κλινική Ερευνήτρια, Department of Stroke Medicine, Imperial College London,
More informationHYPERTENSION. Background for understanding the Hypertension literature. Case presentation. Approach to Treatment. Jeffrey J. Kaufhold, MD Nephrology
HYPERTENSION Background for understanding the Hypertension literature. Case presentation Approach to Treatment Jeffrey J. Kaufhold, MD Nephrology 2009 HYPERTENSION SUMMARY Background for understanding
More informationChapter 10. Learning Objectives. Learning Objectives 9/11/2012. Congestive Heart Failure
Chapter 10 Congestive Heart Failure Learning Objectives Explain concept of polypharmacy in treatment of congestive heart failure Explain function of diuretics Learning Objectives Discuss drugs used for
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 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 informationMANAGEMENT OF HYPERTENSION IN PREGNANCY, THE ALGORHITHM
MANAGEMENT OF HYPERTENSION IN PREGNANCY, THE ALGORHITHM Are Particular Anti-hypertensives More Effective or Harmful Than Others in Hypertension in Pregnancy? Existing data is inadequate Methyldopa and
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 informationAgenda. Management of Accelerated Hypertension (Updated in 2017) Salwa Roshdy Prof. of Cardiology Assiut University CardioEgypt 23/2/2017 2/27/2017
Management of Accelerated Hypertension (Updated in 2017) By Salwa Roshdy Prof. of Cardiology Assiut University CardioEgypt 23/2/2017 Agenda Definition of Accelerated HTN Pathophysiology & Etiology Prognosis
More informationManaging Hypertension in the Perioperative Arena
Managing Hypertension in the Perioperative Arena Optimizing Perioperative Management Strategies for Hypertension in the Cardiac Surgical Patient Objectives: Treatment of hypertensive emergencies. ALBERT
More informationBlood Pressure Management in Acute Stroke. Bradley Molyneaux, M.D., Ph.D. Departments of Neurology & Critical Care Medicine University of Pittsburgh
Blood Pressure Management in Acute Stroke Bradley Molyneaux, M.D., Ph.D. Departments of Neurology & Critical Care Medicine University of Pittsburgh 80 yo M w/ R MCA syndrome NIHSS 14 A balancing act Cerebral
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 informationObjectives DISCLOSURES NONE. Hypertensive Urgency & Hypertensive Emergency. Define Hypertensive Urgency vs Emergency
Hypertensive Urgency & Hypertensive Emergency 15 th Annual Rocky mountain Hospital Medicine Symposium November 6-7 th, 2017 Renaissance Hotel Denver DISCLOSURES NONE Objectives Define Hypertensive Urgency
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 informationAntihypertensive Agents Part-2. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia
Antihypertensive Agents Part-2 Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Agents that block production or action of angiotensin Angiotensin-converting
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 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 informationBased on 2014 SOGC Guidelines
Based on 2014 SOGC Guidelines 22nd Edition 2015 1 ICH + gestational hypertension by far the biggest cause of direct maternal deaths New stats coming in 2013 OCR 22nd Edition 2015 2 Diastolic 90 mmhg is
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 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 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 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 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 informationCHAPTER 12 HYPERTENSION IN SPECIAL GROUPS HYPERTENSION IN PREGNANCY
CHAPTER 12 HYPERTENSION IN SPECIAL GROUPS HYPERTENSION IN PREGNANCY v Mild preeclampsia is managed by close observation of the mother and fetus preferably in hospital. If the diastolic blood pressure remains
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 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 informationNURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOLS. ACUTE CEREBROVASCULAR ACCIDENT TPA (ACTIVASE /alteplase) FOR THROMBOLYSIS
NURSING DEPARTMENT CRITICAL CARE POLICY MANUAL CRITICAL CARE PROTOCOLS ACUTE CEREBROVASCULAR ACCIDENT TPA (ACTIVASE /alteplase) FOR THROMBOLYSIS I. Purpose : A. To reduce morbidity and mortality associated
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 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 informationObjectives: HYPERTENSIVE EMERGENCIES:
HYPERTENSIVE EMERGENCIES: Acute Care Evaluation and Management Charles V. Pollack, Jr., MD Christopher J. Rees, MD Department of Emergency Medicine, Pennsylvania Hospital University of Pennsylvania, Philadelphia,
More informationFranklin Delano Roosevelt. Learning Objectives. Severe hypertension is relatively common. Current State of Hypertensive Crisis Management
3 3:45 pm Presenter Disclosure Information What Every Primary Care Clinician Needs to Know about Hypertension Crises SPEAKER Karol E. Watson, MD, PhD, FACC The following relationships exist related to
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 informationPredicting and changing the future for people with CKD
Predicting and changing the future for people with CKD I. David Weiner, M.D. Co-holder, C. Craig and Audrae Tisher Chair in Nephrology Professor of Medicine and Physiology and Functional Genomics University
More informationUpdate in Hypertension
Update in Hypertension Eliseo J. PérezP rez-stable MD Professor of Medicine DGIM, Department of Medicine UCSF 20 May 2008 Declaration of full disclosure: No conflict of interest (I have never been funded
More informationCategories of HTN. Overview of Hypertension. Types of Hypertension
Categories of HTN Overview of Hypertension Normal SBP 100 Quick review of the Basics: What is
More informationWhat is hypertension?
HYPERTENSION What is hypertension? Abnormally elevated arterial blood pressure that is usually indicated by an adult systolic blood pressure of 140 mm Hg or greater or a diastolic blood pressure of 90
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 informationTREATMENT OF HYPERTENSION
TREATMENT OF HYPERTENSION Aim of treatment BP Goals Main items of treatment Lifestyle modification When to start drug Rx Pharmacological therapy 1. Relief of symptoms 2. Prevention of complications and
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 informationLEARNING OBJECTIVES 2/20/2017
HYPERTENSION IN PREGNANCY: PREVENTING SEVERE MATERNAL MORBIDITY & MORTALITY THROUGH THE IMPLEMENTATION OF EVIDENCED BASED PROTOCOLS Laura Senn, RN, PhD, CNS Sutter Medical Center, Sacramento LEARNING OBJECTIVES
More informationCurrent State of Hypertensive Crisis Management. Learning Objectives. Severe hypertension is relatively common. Hypertension Emergencies in context
2:30 3:15 pm Presenter Disclosure Information What Every Primary Care Clinician Needs to Know about Hypertension Crises SPEAKER Karol E. Watson, MD, PhD, FACC The following relationships exist related
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 informationHow to Handle Hypertension Crisis
How to Handle Hypertension Crisis Learning Objectives 1. Define hypertensive crises: Hypertension urgency and hypertension emergency 2. Outline the pathophysiology of hypertensive urgencies and emergencies
More informationChildren with Hypertension in ED
Children with Hypertension in ED By Prof. Sanaa AK Helmy Professor of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Cairo University Vice-chairman of the Egyptian Society of Emergency
More informationMANAGEMENT OF HYPERTENSION: TREATMENT THRESHOLDS AND MEDICATION SELECTION
Management of Hypertension: Treatment Thresholds and Medication Selection Robert B. Baron, MD MS Professor and Associate Dean Declaration of full disclosure: No conflict of interest Presentation Goals
More informationManagement of High Blood Pressure in Adults
Management of High Blood Pressure in Adults Based on the Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC8) James, P. A. (2014, February 05). 2014 Guideline for Management
More 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 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 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 informationSBP in range of 120 to 140 :no progression or regression of CAD. Sipahi et al., 2006
Management of Hypertension in Patients with CAD M. Mohsen Ibrahim, MD Cardiology Department- Cairo University 1. What is the optimal BP in patients with hypertension and CAD? 2. What is the minimum safe
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 informationCMQCC Preeclampsia Tool Kit: Hypertensive Disorders Across the Lifespan
CMQCC Preeclampsia Tool Kit: Hypertensive Disorders Across the Lifespan Carol J Harvey, MS, BSN, RNC-OB, C-EFM, CS Northside Hospital Atlanta Cherokee - Forsyth New! Improving Health Care Response to Preeclampsia:
More informationHeart Failure Clinician Guide JANUARY 2018
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Heart Failure Clinician Guide JANUARY 2018 Introduction This evidence-based guideline summary is based on the 2018 National Heart Failure Guideline.
More informationTony L Smith DNP RN ACNP CCRN CFRN EMT-IV Vanderbilt LifeFlight
Treatment of a Stroke patient: A look at how to care for the Stroke patient in the aeromedical setting Tony L Smith DNP RN ACNP CCRN CFRN EMT-IV Vanderbilt LifeFlight Objectives 1. Discuss the assessment
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 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 informationOCTOBER 7-10 PHILADELPHIA, PENNSYLVANIA
OMED 17 OCTOBER 7-10 PHILADELPHIA, PENNSYLVANIA 29.5 Category 1-A CME credits anticipated ACOFP / AOA s 122 nd Annual Osteopathic Medical Conference & Exposition ACOFP - The Heart of the Matter - An Evidence
More informationHypertension in the ED - management tips that will bring down your own BP
27th Annual Update in Emergency Medicine Hypertension in the ED - management tips that will bring down your own BP February 24, 2014 Clare Atzema, MD MSc FRCPC Staff Physician, Sunnybrook Health Sciences
More informationManaging Hypertension in Diabetes Sean Stewart, PharmD, BCPS, BCACP, CLS Internal Medicine Park Nicollet Clinic St Louis Park.
Managing Hypertension in Diabetes 2015 Sean Stewart, PharmD, BCPS, BCACP, CLS Internal Medicine Park Nicollet Clinic St Louis Park Case Scenario Mike M is a 59 year old man with type 2 diabetes managed
More informationManagement of Hypertension
Clinical Practice Guidelines Management of Hypertension Definition and classification of blood pressure levels (mmhg) Category Systolic Diastolic Normal
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 informationAWHONN Oregon Section 2014
AWHONN Oregon Section 2014 Carol J Harvey, MS, BSN, RNC-OB, C-EFM, CS Northside Hospital Atlanta Cherokee - Forsyth Hypertensive in Pregnancy Carol J Harvey, MS, RNC-OB, C-EFM Clinical Specialist Northside
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 informationChapter 23. Media Directory. Cardiovascular Disease (CVD) Hypertension: Classified into Three Categories
Chapter 23 Drugs for Hypertension Slide 37 Slide 41 Media Directory Nifedipine Animation Doxazosin Animation Upper Saddle River, New Jersey 07458 All rights reserved. Cardiovascular Disease (CVD) Includes
More information7/7/ CHD/MI LVH and LV dysfunction Dysrrhythmias Stroke PVD Renal insufficiency and failure Retinopathy. Normal <120 Prehypertension
Prevalence of Hypertension Hypertension: Diagnosis and Management T. Villela, M.D. Program Director University of California, San Francisco-San Francisco General Hospital Family and Community Medicine
More informationHeart Failure Clinician Guide JANUARY 2016
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Heart Failure Clinician Guide JANUARY 2016 Introduction This evidence-based guideline summary is based on the 2016 National Heart Failure Guideline.
More informationPolicy REVISED: 6/30/2016 3:30 PM. Applies To: ObGyn Responsible Department: ObGyn Revised: June 30, 2016
Title: Antihypertensive Treatment for Severe Hypertension During Pregnancy Applies To: ObGyn Responsible Department: ObGyn Revised: June 30, 2016 Policy POLICY STATEMENT: Pregnant or postpartum patients
More informationCHALLENGES OF HYPERTENSION IN THE COALFACE
CHALLENGES OF HYPERTENSION IN THE COALFACE Y VERIAVA CENTRE FOR RURAL HEALTH SCHOOL OF CLINICAL MEDICINE FACULTY OF HEALTH SCIENCES UNIVERSITY OF WITWATERSRAND SYSTOLIC AND DIASTOLIC BLOOD PRESSURES (BP)
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 informationPreeclampsia: What s old is new again. Gene Chang, MD Maternal Fetal Medicine
Preeclampsia: What s old is new again Gene Chang, MD Maternal Fetal Medicine Objectives Define Preeclampsia Review current guidelines Role of proteinuria Timing of delivery Seizure prevention Severe Hypertension
More informationBlood Pressure. Michelle Bertram- Nephrology- OBH
Blood Pressure Michelle Bertram- Nephrology- OBH Hypertension- how common? 29-30% white adults 46-51% uncontrolled Diagnosis Two or more properly measured BP s after an initial screen NICE guidelines also
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 informationStroke in Pregnancy. Stroke in Pregnancy 6/23/13
G5#$#Preven*ng#Maternal#Morbidity#and#Mortality#Via# Expanded#Scope#of#Nursing#Prac*ce#As#First#Responder# in#hypertensive#crisis#of#preeclampsia# The$presenter$reports$no$relevant,$influencing$financial$rela5onships.$
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 informationClinical Controversies in Perioperative Medicine
Update on Perioperative Medicine Clinical Controversies in Perioperative Medicine Hugo Quinny Cheng, MD Division of Hospital Medicine University of California, San Francisco Cardiac Medications & Perioperative
More informationCerebral Autoregulation What s the Big Deal? Kathy Morrison MSN, RN, CNRN Gayle Watson MSN, RN, CCNS, CCRN
Cerebral Autoregulation What s the Big Deal? Kathy Morrison MSN, RN, CNRN Gayle Watson MSN, RN, CCNS, CCRN Background 30% of patients have history of hypertension prior to stroke 80% will present with
More informationHeart Failure. Subjective SOB (shortness of breath) Peripheral edema. Orthopnea (2-3 pillows) PND (paroxysmal nocturnal dyspnea)
Pharmacology I. Definitions A. Heart Failure (HF) Heart Failure Ezra Levy, Pharm.D. HF Results when one or both ventricles are unable to pump sufficient blood to meet the body s needs There are 2 types
More informationCreative blood pressure management: whys and the tricks
Creative blood pressure management: whys and the tricks Cynthia D. Caraballo-Hunt, MD Kaiser/OHSU Family Medicine Faculty Beaverton Medical Office NW Permanente, Portland, OR Objectives 1. Describe current
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 informationMedical Treatment for acute Decompensated Heart Failure. Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011
Medical Treatment for acute Decompensated Heart Failure Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011 2010 HFSA guidelines for ADHF 2009 focused update of the 2005 American College
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 informationSummary/Key Points Introduction
Summary/Key Points Introduction Scope of Heart Failure (HF) o 6.5 million Americans 20 years of age have HF o 960,000 new cases of HF diagnosed annually o 5-year survival rate for HF is ~50% Classification
More informationHypertension: JNC-7. Southern California University of Health Sciences Physician Assistant Program
Hypertension: JNC-7 Southern California University of Health Sciences Physician Assistant Program Management and Treatment of Hypertension April 17, 2018, presented by Ezra Levy, Pharm.D.! Reference Card
More informationAudience Response. Hypertension. Case: Mr. J. Measuring BP. Non-pharmacologic intervention. Case: Mr. J. Session ID: HTN411
Audience Response http://rwpoll.com OR App downloads: Hypertension Chris Knight, MD cknight@uw.edu http://tiny.cc/rwiphone http://tiny.cc/rwdroid Session ID: HTN411 Case: Mr. J 52 y/o male patient comes
More informationHypertension Management in Diabetic Patients
Hypertension Management in Diabetic Patients Park, Chang G, MD, PhD Cardiovascular Center, Guro Hospital, Korea University Medical School Contents (Treatment of 2 Cases) Type 2 Diabetes Mellitus Hypertension
More informationClinical Controversies in Perioperative Medicine!
Clinical Controversies in Perioperative Medicine! Hugo Quinny Cheng, MD! Division of Hospital Medicine! University of California, San Francisco! Disclosures! Perioperative beta-blockade & statin therapy
More informationBlood Pressure Treatment Goals
Blood Pressure Treatment Goals Kenneth Izuora, MD, MBA, FACE Associate Professor UNLV School of Medicine November 18, 2017 Learning Objectives Discuss the recent studies on treating hypertension Review
More informationA very short lecture.
Medical Treatment of Type A Aortic Dissection: Tales of Turkeys, Tygon Tubing, and Evolving Paradigms The Houston Aortic Symposium April 4-6, 2008 John A. Elefteriades, MD William W.L. Glenn Professor
More informationDisclosure Information : No conflict of interest
Intravenous nicorandil improves symptoms and left ventricular diastolic function immediately in patients with acute heart failure : a randomized, controlled trial M. Shigekiyo, K. Harada, A. Okada, N.
More informationAntihypertensive drugs SUMMARY Made by: Lama Shatat
Antihypertensive drugs SUMMARY Made by: Lama Shatat Diuretic Thiazide diuretics The loop diuretics Potassium-sparing Diuretics *Hydrochlorothiazide *Chlorthalidone *Furosemide *Torsemide *Bumetanide Aldosterone
More information