Masked Hypertension. Why Should We Care? Dr. Peter J. Lin Director Primary Care Initiatives - Canadian Heart Research Centre
|
|
- Spencer Casey
- 6 years ago
- Views:
Transcription
1 Masked Hypertension Why Should We Care? Dr. Peter J. Lin Director Primary Care Initiatives - Canadian Heart Research Centre
2 PRESENTER DISCLOSURE Faculty: Dr. Peter Lin Relationships with commercial interests: Grants/Research Support: None Speakers Bureau/Honoraria: Astrazeneca, BMS, Takeda, Purdue Boeringher Ingelheim, Bayer, Eli Lilly, Amgen, Janssen, Forest Laboratories, J&J, Merck, Novartis, Pfizer, Servier, Sanofi, Abbott, Mylan Consulting Fees: Astrazeneca, Boeringher Ingelheim, Bayer, Eli Lilly, Merck, Sanofi, Amgen, MdBriefCase Other: None
3 MITIGATING POTENTIAL BIAS Potential bias was mitigated through the use of current Hypertension Canada guidelines as the primary literature source for recommendations in the slide deck.
4 Key Opinion Leaders : Please do not measure the blood pressure because you might want to treat it.
5
6
7 Cardiovascular Mortality Risk Doubles with each 20/10 mmhg Increase in Systolic/Diastolic BP* Cardiovascular mortality risk 8 6 8X risk X risk 2X risk 4X risk 115/75 135/85 155/95 175/105 Systolic BP/Diastolic BP (mmhg) *Individuals aged years Lewington et al. Lancet 2002;360:
8 SBP Reduction and CV Mortality 1.50 MIDAS/NICS/VHAS UKPDS C vs A P = Odds Ratio NORDIL STOP ACEIs STOP CCBs CAPPP INSIGHT HOT L vs H HOT M vs H MRC1 MRC2 HOPE STONE SHEP HEP Syst-Eur UKPDS L vs H Syst-China PART 2/SCAT ATMH STOP-1 EWPHE RCT Staessen JA, et al. Lancet. 2001;358: Difference in SBP (mm Hg)
9 SBP Reduction and CV Mortality 1.50 P = Odds Ratio Staessen JA, et al. Lancet. 2001;358: Difference in SBP (mm Hg)
10
11 Measuring Blood Pressure 140 Home or Daytime ABPM SBP mmhg Office SBP mmhg 2009 Canadian Hypertension Education Program Recommendations Derived from Pickering et al. Hypertension 2002: 40:
12 Measuring Blood Pressure 140 Home or Daytime ABPM SBP mmhg 135 True Normotensive True hypertensive White Coat HTN Office SBP mmhg 2009 Canadian Hypertension Education Program Recommendations Derived from Pickering et al. Hypertension 2002: 40:
13 Stroke: Normotensive vs WCH vs Hypertensive Verdecchia P et al. Hypertension 2005;45:
14 Stroke: Normotensive vs WCH vs Hypertensive Verdecchia P et al. Hypertension 2005;45:
15 Measuring Blood Pressure 140 Home or Daytime ABPM SBP mmhg 135 Masked HTN True Normotensive True hypertensive White Coat HTN Office SBP mmhg 2009 Canadian Hypertension Education Program Recommendations Derived from Pickering et al. Hypertension 2002: 40:
16 Measuring Blood Pressure 140 Home or Daytime ABPM SBP mmhg 135 Masked HTN True Normotensive True hypertensive White Coat HTN Office SBP mmhg 2009 Canadian Hypertension Education Program Recommendations Derived from Pickering et al. Hypertension 2002: 40:
17 Measuring Blood Pressure 140 Home or Daytime ABPM SBP mmhg 135 Masked HTN True Normotensive True hypertensive White Coat HTN 135 Office SBP mmhg 2009 Canadian Hypertension Education Program Recommendations Derived from Pickering et al. Hypertension 2002: 40:
18
19 Prevalence of Masked Hypertension Overall, the prevalence of masked hypertension is: about 10% in the general population about 30% in treated hypertensive patients higher in patients with diabetes and chronic kidney disease patients 18
20 19
21 ACCOMPLISH trial : ACEi CCB vs ACEi HCTZ ACEi + HCTZ ACEi + CCB Absolute risk reduction in primary outcome events (i.e., CV death, nonfatal MI, nonfatal stroke, hospitalization for angina, resuscitation after sudden cardiac arrest, coronary revascularization): 2.2% Absolute risk reduction in deaths from CV causes: 0.4% 1. Jamerson K, et al. N Engl J Med. 2008;359(23):
22 Non-persistence with AntihypertensiveTherapy Leads to Increased Risk of Myocardial Infarction or Stroke 2 1 Acute MI 1.15 ( ) Stroke 1.28 ( ) 0 Risk* of MI or stroke associated with nonpersistent use of antihypertensive therapy relative to 2-year persistent use *Adjusted for gender, age, prescriber, initial antihypertensive, number of antihypertensives and other CV drugs 21 Values in parentheses are the 95% confidence intervals Breekveldt-Postma NS, et al. 2008
23 Poor Compliance is Linked to Hospitalization Risk All-cause hospitalization risk (%) 50 * 44 * 39 * * (n=350) (n=344) (n=562) (n=921) (n=5804) Level of compliance (%) The probability of one or more hospitalizations during a 12-month period *p<0.05 vs % compliant group 22 Sokol MC, et al. 2005
24 ACCORD Blood Pressure 135 mmhg 120 mmhg The ACCORD Study Group. N Engl J Med 2010; /NEJMoa
25 The ACCORD Study Group. N Engl J Med 2010; /NEJMoa
26 Cardiovascular Mortality Risk Doubles with each 20/10 mmhg Increase in Systolic/Diastolic BP* Cardiovascular mortality risk 8 6 8X risk X risk 2X risk 4X risk 115/75 135/85 155/95 175/105 Systolic BP/Diastolic BP (mmhg) *Individuals aged years Lewington et al. Lancet 2002;360:
27 mmhg 200 BP reductions achieved in recent trials HOPE PROGRESS CAPPP INSIGHT 190 NORDIL SBP HOT STONE STOP ALLHAT 1 LIFE 150 ALLHAT 2 ANBP2 140 INVEST 130 SCOPE ASCOT VALUE Mancia and Grassi J.Hypertension 2002 updated
28 Recommendations: Hypertension/ Blood Pressure Control (2) Systolic Targets: People with diabetes and hypertension should be treated to a systolic blood pressure goal of <140 mmhg. A American Diabetes Association Standards of Medical Care in Diabetes. Cardiovascular disease and risk management. Diabetes Care 2017; 40 (Suppl. 1): S75-S87
29 Stroke benefit The ACCORD Study Group. N Engl J Med 2010; /NEJMoa
30 Recommendations: Hypertension/ Blood Pressure Control (2) Systolic Targets: People with diabetes and hypertension should be treated to a systolic blood pressure goal of <140 mmhg. A Lower systolic targets, such as <130 mmhg, may be appropriate for certain individuals at high risk of CVD, if they can be achieved without undue treatment burden. C American Diabetes Association Standards of Medical Care in Diabetes. Cardiovascular disease and risk management. Diabetes Care 2017; 40 (Suppl. 1): S75-S87
31 mmhg 200 BP reductions achieved in recent trials HOPE PROGRESS CAPPP INSIGHT mmhg NORDIL HOT SBP STONE STOP DBP ALLHAT LIFE 90 ALLHAT ANBP INVEST 130 SCOPE ASCOT VALUE 70 Mancia and Grassi J.Hypertension 2002 updated
32 BP Control Reduces CV Events: HOT Trial Diabetes Subgroup P<0.005 Goal of therapy: target diastolic BP MI, stroke, CV mortality/1000 pt-y < 80 mmhg 90 mm Hg (n=501) 85 mm Hg (n=501) 80 mm Hg (n=499) 5 0 < 85 mmhg Hansson et al. Lancet. 1998;351:1755.
33 Blood Pressure Lowering Therapy Evidence: Effect of Intensive Blood Pressure Control Hypertension Optimal Treatment (HOT) Study 18,790 patients with a baseline diastolic BP of mm Hg randomized to a target diastolic BP of <90 mm Hg, <85 mm Hg, or <80 mm Hg Major CV events per 1000 patient-years Patients with Diabetes Patients without Diabetes Diastolic BP goal Diastolic BP goal More intensive blood pressure control provides greater benefit in patients with diabetes BP=Blood pressure, CV=Cardiovascular Source: Hansson L et al. Lancet 1998;351:
34 Recommendations: Hypertension/ Blood Pressure Control (3) Diastolic Targets: Patients with diabetes should be treated to a diastolic blood pressure <90 mmhg. A Lower diastolic targets, such as <80 mmhg, may be appropriate for certain individuals at high risk for CVD if they can be achieved without undue treatment burden. C American Diabetes Association Standards of Medical Care in Diabetes. Cardiovascular disease and risk management. Diabetes Care 2017; 40 (Suppl. 1): S75-S87
35 Pre SPRINT Targets Population SBP DBP High Risk (SPRINT) 120 NA Diabetes < 130 < 80 All others* < 140 < 90 *Target BP with Automated Office Blood Pressure (AOBP) threshold < 135/85 Leung AA CHEP Guidelines. Hypertension Canada s 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Can Cardio Soc 2016;32:
36 SPRINT Trial ACCORD Trial Patients (n=9361) age 50 years SBP 130 mm Hg CV risk (but without diabetes) assigned to: o SBP target <120 mm Hg (intensive treatment), or o SBP target <140 mm Hg (standard treatment) Primary composite outcome: MI, other acute coronary syndromes, stroke, HF, or death from CV causes 1. SPRINT Research Group. N Engl J Med 2015.
37 Year 1 Mean SBP mm Hg Standard Mean SBP mm Hg Intensive
38 SPRINT Primary Outcome Hazard Ratio = 0.75 (95% CI: 0.64 to 0.89) Standard (319 events) Intensive (243 events) Mean Follow up = 3.26 years NNT=61 Number of Participants
39 All cause Mortality Hazard Ratio = 0.73 (95% CI: 0.60 to 0.90) NNT = 90 Median = 3.26 years Standard (210 deaths) Adapt from Figure 2B in the N Engl J Med manuscript Intensive (155 deaths) Include NNT
40 Primary Outcome Experience in the Six Pre specified Subgroups of Interest *Treatment by subgroup interaction
41 SPRINT Treatment Algorithm Intensive Treatment May begin with a single agent for Age >75 or Older with SBP < 140 on 0 1 med at study entry. Second drug Added at 1 month visit if asymptomatic and SBP > 130
42 Number (%) of Participants with a Monitored Clinical Measure During Follow up Number (%) of Participants Intensive Standard HR (P Value) Laboratory Measures 1 Sodium <130 mmol/l 180 (3.9) 100 (2.2) 1.76 (<0.001) Potassium <3.0 mmol/l 114 (2.5) 74 (1.6) 1.50 (0.006) Potassium >5.5 mmol/l 176 (3.8) 171 (3.7) 1.00 (0.97) Signs and Symptoms Orthostatic hypotension (16.6) 857 (18.3) 0.88 (0.013) Orthostatic hypotension with dizziness 62 (1.3) 71 (1.5) 0.85 (0.35) 1. Detected on routine or PRN labs; routine labs drawn quarterly for first year, then q 6 months 2. Drop in SBP 20 mmhg or DBP 10 mmhg 1 minute after standing (measured at 1, 6, and 12 months and yearly thereafter)
43 Number (%) of Participants with a Monitored Clinical Measure During Follow up Number (%) of Participants Intensive Standard HR (P Value) Laboratory Measures 1 Sodium <130 mmol/l 180 (3.9) 100 (2.2) 1.76 (<0.001) Potassium <3.0 mmol/l 114 (2.5) 74 (1.6) 1.50 (0.006) Potassium >5.5 mmol/l 176 (3.8) 171 (3.7) 1.00 (0.97) Signs and Symptoms Orthostatic hypotension (16.6) 857 (18.3) 0.88 (0.013) Orthostatic hypotension with dizziness 62 (1.3) 71 (1.5) 0.85 (0.35) 1. Detected on routine or PRN labs; routine labs drawn quarterly for first year, then q 6 months 2. Drop in SBP 20 mmhg or DBP 10 mmhg 1 minute after standing (measured at 1, 6, and 12 months and yearly thereafter)
44 Serious Adverse Events* (SAE) During Follow up Number (%) of Participants Intensive Standard HR (P Value) All SAE reports 1793 (38.3) 1736 (37.1) 1.04 (0.25) SAEs associated with Specific Conditions of Interest Hypotension 110 (2.4) 66 (1.4) 1.67 (0.001) Syncope 107 (2.3) 80 (1.7) 1.33 (0.05) Injurious fall 105 (2.2) 110 (2.3) 0.95 (0.71) Bradycardia 87 (1.9) 73 (1.6) 1.19 (0.28) Electrolyte abnormality 144 (3.1) 107 (2.3) 1.35 (0.020) Acute kidney injury or acute renal failure 193 (4.1) 117 (2.5) 1.66 (<0.001) *Fatal or life threatening event, resulting in significant or persistent disability, requiring or prolonging hospitalization, or judged important medical event.
45 Serious Adverse Events* (SAE) During Follow up Number (%) of Participants Intensive Standard HR (P Value) All SAE reports 1793 (38.3) 1736 (37.1) 1.04 (0.25) SAEs associated with Specific Conditions of Interest Hypotension 110 (2.4) 66 (1.4) 1.67 (0.001) Syncope 107 (2.3) 80 (1.7) 1.33 (0.05) Injurious fall 105 (2.2) 110 (2.3) 0.95 (0.71) Bradycardia 87 (1.9) 73 (1.6) 1.19 (0.28) Electrolyte abnormality 144 (3.1) 107 (2.3) 1.35 (0.020) Acute kidney injury or acute renal failure 193 (4.1) 117 (2.5) 1.66 (<0.001) *Fatal or life threatening event, resulting in significant or persistent disability, requiring or prolonging hospitalization, or judged important medical event.
46 Serious Adverse Events* (SAE) During Follow up Number (%) of Participants Intensive Standard HR (P Value) All SAE reports 1793 (38.3) 1736 (37.1) 1.04 (0.25) SAEs associated with Specific Conditions of Interest Hypotension 110 (2.4) 66 (1.4) 1.67 (0.001) Syncope 107 (2.3) 80 (1.7) 1.33 (0.05) Injurious fall 105 (2.2) 110 (2.3) 0.95 (0.71) Bradycardia 87 (1.9) 73 (1.6) 1.19 (0.28) Electrolyte abnormality 144 (3.1) 107 (2.3) 1.35 (0.020) Acute kidney injury or acute renal failure 193 (4.1) 117 (2.5) 1.66 (<0.001) *Fatal or life threatening event, resulting in significant or persistent disability, requiring or prolonging hospitalization, or judged important medical event.
47 Old BP Targets Population SBP DBP High Risk (SPRINT) 120 NA Diabetes < 130 < 80 All others* < 140 < 90 *Target BP with Automated Office Blood Pressure (AOBP) threshold < 135/85 Leung AA CHEP Guidelines. Hypertension Canada s 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Can Cardio Soc 2016;32:
48 New BP Targets (Post SPRINT) Population SBP DBP High Risk (SPRINT) 120 NA Diabetes < 130 < 80 All others* < 140 < 90 *Target BP with Automated Office Blood Pressure (AOBP) threshold < 135/85 Leung AA CHEP Guidelines. Hypertension Canada s 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Can Cardio Soc 2016;32:
49 Who is a High Risk (SPRINT) Patient? Someone with any of the following: Leung AA CHEP Guidelines. Hypertension Canada s 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Can Cardio Soc 2016;32:
50 Who is a High Risk (SPRINT) Patient? Someone with any of the following: CVD - Clinical or sub-clinical CKD (non-diabetic nephropathy, proteinuria <1 g/d, * egfr ml/min/1.73m 2 ) CV Risk - Estimated 10-year global CV risk 15% Age 75 years * Four variable MDRD equation Framingham Risk Score Leung AA CHEP Guidelines. Hypertension Canada s 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Can Cardio Soc 2016;32:
51 How do you make it easy? Systolic 120 < 130/80 <140/90 Diabetes CVD CKD (egfr 20-59) CV Risk > 15% Age > 75 Nothing from list
52 SBP
53 DBP
54 INVEST International Verapamil SR Trandolapril study MI and Stroke based on Diastolic Blood Pressure Achieved DBP Ann Intern Med. 2006;144:
55 INVEST International Verapamil SR-Trandolapril study MI and Stroke based on Diastolic Blood Pressure Achieved DBP Ann Intern Med. 2006;144:
56 2009 by Radiological Society of North America Baumüller S et al. Radiology 2009;253:56-64
57 Ann Intern Med. 2006;144:
58 Variable Mean ± SD or% No. of diseased vessels 1 0.1% % % No. of Diseased Vessels % Location of disease LAD 98.9% LCX 92.6% RCA 91.7% Proximal LAD involvement (target lesion = LAD located in proximal) 13.8% No. of lesions per patient 5.7 ±2.2 (1888) No. of Lesions per Patient Extent of disease per patient (total length of lesions, mm) 77.6 ± 33.8 (1888) Duke jeopardy score 9.3 ± 3.1 (1874) LVEF (%) 66.2 ± 11.3 (1291) LVEF >50% 90.9% 35% 50% 8.0% <35% 1.1%
59 Measure BP Properly Outside BP Systolic 120 < 130/80 <140/90 Diabetes CVD CKD (egfr 20-59) CV Risk > 15% Age > 75 Nothing from list
60 ALLHAT Number of Pills Needed Drug 2 Drugs 3 Drugs Patients (%) Average # of drugs 0 6 mos 1 yr 3 yr 5 yr 0 Blood pressure controlled <140/90 mmhg 49.8% 55.2% 62.3% 65.6% Cushman WC, et al. J Clin Hypertens. 2002;4:
61 Single Pill Combo and adherence 1. Sherrill B, et al. J Clin Hypertens. 2011;13(12):
62 Combine or Double Up? Ratio of Incremental SBP Lowering Effect at Standard Dose Incremental SBP reduction ratio observed/expected (additive) CCB = calcium channel blocker 1. Wald DS, et al. Am J Med 2009;122:290
63 CV risk Initial combination therapy 1. Corrao G, et al. Hypertension. 2011;58(4):
64 What can you combine? A: ACEI inhibitors ARBs B: Beta-blockers C: CCB D: Diuretics E: Everything else DRI (Direct Renin Inhibitor) Alpha-blockers (doxazosin, terazosin) Vasodilators (hydralazine, minoxidil) Central sympatholytics (clonidine, methyldopa) 63
65 Amlodipine Dilates ACEi Dilates 64
66 Amlodipine Dilates ACEi Dilates
67 STITCH algorithm 1. Feldman RD, et al. Hypertension. 2009;53(4):
68 STITCH study: Results Absolute difference: 12.0% 95% CI % P = Feldman RD, et al. Hypertension. 2009;53(4):
69 68
70 First Line Treatment of Adults with Systolic/Diastolic Hypertension Without Other Compelling Indications TARGET <135/85 mmhg (automated measurement method) INITIAL TREATMENT Health behaviour management Thiazide/ thiazide like* ACEI ARB Long acting CCB Betablocker Single pill combination ** * Longer acting (thiazide like) diuretics are preferred over shorter acting (thiazide) diuretics BBs are not indicated as first line therapy for age 60 and above Renin angiotensin system (RAS) inhibitors are contraindicated in pregnancy and caution is required in prescribing to women of child bearing potential **Recommended SPC choices are those in which an ACE I is combined with a CCB, an ARB with a CCB, or an ACE I or ARB with a diuretic
Hypertension Putting the Guidelines into Practice
Hypertension 2017 Putting the Guidelines into Practice Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or
More informationHypertension and Cardiovascular Disease
Hypertension and Cardiovascular Disease Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or by any means graphic,
More 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 informationSystolic Blood Pressure Intervention Trial (SPRINT)
09:30-09:50 2016.4.15 Systolic Blood Pressure Intervention Trial (SPRINT) IN A NEPHROLOGIST S VIEW Sejoong Kim Seoul National University Bundang Hospital Current guidelines for BP control Lowering BP
More informationHypertension Putting the Guidelines into Practice
Hypertension 2017 Putting the Guidelines into Practice Disclosures Relationships with commercial interests: Grants/Research Support: Speakers Bureau/Honoraria: Consulting Fees: Data Safety and Monitoring:
More 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 informationTreating Hypertension in 2018: What Makes the Most Sense Today?
Treating Hypertension in 2018: What Makes the Most Sense Today? Daniel Blanchard, MD Professor of Medicine UC San Diego Cardiovascular Center La Jolla, California 1 2 Speaker Disclosures Consultant and/or
More informationHypertension targets: sorting out the confusion. Brian Rayner, Division of Nephrology and Hypertension, University of Cape Town
Hypertension targets: sorting out the confusion Brian Rayner, Division of Nephrology and Hypertension, University of Cape Town Historical Perspective The most famous casualty of this approach was the
More informationHypertension Update. Faculty/Presenter Disclosure
Hypertension Update Who Gives a CHEP About Targets? Faculty/Presenter Disclosure Presenter: Raj Padwal Relationships that may introduce potential bias and/or conflict of interest: Grants/Research Support:
More informationHypertension Management Controversies in the Elderly Patient
Hypertension Management Controversies in the Elderly Patient Juan Bowen, MD Geriatric Update for the Primary Care Provider November 17, 2016 2016 MFMER slide-1 Disclosure No financial relationships No
More 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 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 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 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 informationBlood Pressure Targets: Where are We Now?
Blood Pressure Targets: Where are We Now? Diana Cao, PharmD, BCPS-AQ Cardiology Assistant Professor Department of Clinical & Administrative Sciences California Northstate University College of Pharmacy
More informationHypertension 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 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 information4/4/17 HYPERTENSION TARGETS: WHAT DO WE DO NOW? SET THE STAGE BP IN CLINICAL TRIALS?
HYPERTENSION TARGETS: WHAT DO WE DO NOW? MICHAEL LEFEVRE, MD, MSPH PROFESSOR AND VICE CHAIR DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE UNIVERSITY OF MISSOURI 4/4/17 DISCLOSURE: MEMBER OF THE JNC 8 PANEL
More informationHypertension and Diabetes Should we be SPRINTING or Reaching an ACCORD?
Hypertension and Diabetes Should we be SPRINTING or Reaching an ACCORD? Suzanne Oparil, MD Distinguished Professor of Medicine, Professor of Cell, Developmental and Integrative Biology Director, Vascular
More informationThe New Hypertension Guidelines
The New Hypertension Guidelines Joseph Saseen, PharmD Professor and Vice Chair, Department of Clinical Pharmacy University of Colorado Anschutz Medical Campus Disclosure Joseph Saseen reports no conflicts
More 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 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 informationHow clinically important are the results of the large trials in hypertension?
How clinically important are the results of the large trials in hypertension? Stéphane LAURENT, MD, PhD, FESC Pharmacology Department and PARCC / INSERM U970 Hôpital Européen Georges Pompidou, Université
More 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 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 informationThiazide or Thiazide Like? Choosing Wisely Academic Detailing Conference Digby Pines October 12-14
Thiazide or Thiazide Like? Choosing Wisely Academic Detailing Conference Digby Pines October 12-14 Disclosures Pam McLean-Veysey, Team Leader Drug Evaluation Unit DEU funded by the Drug Evaluation Alliance
More informationHypertension Management: A Moving Target
9:45 :30am Hypertension Management: A Moving Target SPEAKER Karol Watson, MD, PhD, FACC Presenter Disclosure Information The following relationships exist related to this presentation: Karol E. Watson,
More informationHYPERTENSION 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 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 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 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 diagnosis (see detail document) Diabetic. Target less than 130/80mmHg
Hypertension diagnosis (see detail document) Non-diabetic Diabetic Very elderly (older than 80 years) Target less than 140/90mmHg Target less than 130/80mmHg Consider SBP target less than 150mmHg Non-diabetic
More 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 informationModern Management of Hypertension
Modern Management of Hypertension Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Current Status of Hypertension Prevalence
More informationHypertension and the SPRINT Trial: Is Lower Better
Hypertension and the SPRINT Trial: Is Lower Better 8th Annual Orange County Symposium on Cardiovascular Disease Prevention Saturday, October 8, 2016 Keith C. Norris, MD, PhD, FASN Professor of Medicine,
More informationChallenges in Hypertension: Incorporating Evolving Clinical Data Into Practice
Challenges in Hypertension: Incorporating Evolving Clinical Data Into Practice Faculty Jan Basile, MD Professor of Medicine Seinsheimer Cardiovascular Health Program Division of General Internal Medicine
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 informationCombination Therapy for Hypertension
Combination Therapy for Hypertension Se-Joong Rim, MD Cardiology Division, Yonsei University College of Medicine, Seoul, Korea Goals of Therapy Reduce CVD and renal morbidity and mortality. Treat to BP
More informationHypertension. 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 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 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 informationDISCLOSURES OUTLINE OUTLINE 9/29/2014 ANTI-HYPERTENSIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE
ANTI-HYPERTENSIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE DISCLOSURES Editor-in-Chief- Nephrology- UpToDate- (Wolters Klewer) Richard J. Glassock, MD, MACP Geffen School of Medicine at UCLA 1 st Annual Internal
More informationDisclosures. Learning Objectives. Hypertension: a sprint to the finish Ontario Pharmacists Association 1
Disclosures I have no current or past relationships with commercial entities I have received a speaker s fee from the Ontario Pharmacists Association for this learning activity Laura Tsang PharmD Sunnybrook
More informationHypertension Canada CHEP Guidelines for the Management of Hypertension. What s new in the treatment of hypertension? What s still really important?
Hypertension Canada CHEP Guidelines for the Management of Hypertension What s new in the treatment of hypertension? What s still really important? 1 Presenter Disclosure Relationships with commercial interests:
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 informationObjectives. Describe results and implications of recent landmark hypertension trials
Hypertension Update Daniel Schwartz, MD Assistant Professor of Medicine Associate Medical Director of Heart Transplantation Temple University School of Medicine Disclosures I currently have no relationships
More informationHYPERTENSION: UPDATE 2018
HYPERTENSION: UPDATE 2018 From the Cardiologist point of view Richard C Padgett, MD I have no disclosures HYPERTENSION ALWAYS THE ELEPHANT IN THE EXAM ROOM BUT SOMETIMES IT CHARGES HTN IN US ~78 million
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 informationHypertension in 2015: SPRINT-ing ahead of JNC-8. MAJ Charles Magee, MD MPH FACP Director, WRNMMC Hypertension Clinic
Hypertension in 2015: SPRINT-ing ahead of JNC-8 MAJ Charles Magee, MD MPH FACP Director, WRNMMC Hypertension Clinic Conflits of interest? None Disclaimer The opinions contained herein are not to be considered
More informationBlood Pressure Targets in Diabetes
Stockholm, 29 th August 2010 ESC Meeting Blood Pressure Targets in Diabetes Peter M Nilsson, MD, PhD Department of Clinical Sciences University Hospital, Malmö Sweden Studies on BP in DM2 ADVANCE RCT (Lancet
More informationHypertension Update. Mayo Clinic 90 th Annual Clinical Reviews November 2 nd and 16 th, 2016
Mayo Clinic 90 th Annual Clinical Reviews November 2 nd and 16 th, 2016 Hypertension Update Vincent J. Canzanello, M.D. Consultant, Division of Nephrology and Hypertension Professor or Medicine College
More informationHypertension Update 2016 AREEF ISHANI, MD MS CHIEF OF MEDICINE MINNEAPOLIS VA MEDICAL CENTER PROFESSOR OF MEDICINE UNIVERSITY OF MINNESOTA
Hypertension Update 2016 AREEF ISHANI, MD MS CHIEF OF MEDICINE MINNEAPOLIS VA MEDICAL CENTER PROFESSOR OF MEDICINE UNIVERSITY OF MINNESOTA Case 1 What should be your BP goal for an elderly (> 75 yrs of
More informationDiabetes and Hypertension
Diabetes and Hypertension William C. Cushman, MD, FAHA, FACP, FASH Chief, Preventive Medicine, Veterans Affairs Medical Center Professor, Preventive Medicine, Medicine, and Physiology University of Tennessee
More informationALLHAT. Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic
1 U.S. Department of Health and Human Services National Institutes of Health Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker
More informationHypertension Guidelines Michael A. Weber, MD Division of Cardiovascular Medicine State University of New York Downstate Medical Center
Hypertension Guidelines 2016 Michael A. Weber, MD Division of Cardiovascular Medicine State University of New York Downstate Medical Center Speaker Disclosures I disclose that I am a Consultant for: Ablative
More informationPrevention of Heart Failure: What s New with Hypertension
Prevention of Heart Failure: What s New with Hypertension Ali AlMasood Prince Sultan Cardiac Center Riyadh 3ed Saudi Heart Failure conference, Jeddah, 13 December 2014 Background 20-30% of Saudi adults
More informationNew Recommendations for the Treatment of Hypertension: From Population Salt Reduction to Personalized Treatment Targets
New Recommendations for the Treatment of Hypertension: From Population Salt Reduction to Personalized Treatment Targets Sidney C. Smith, Jr. MD, FACC, FAHA Professor of Medicine/Cardiology University of
More informationEvaluation and Management of Hypertension in Women. Vesna D. Garovic, M.D. Moscow, Russia, December 2016
Evaluation and Management of Hypertension in Women Vesna D. Garovic, M.D. Moscow, Russia, December 2016 2016 MFMER 3508058-1 Women are not small men There is nothing as powerful as an idea whose time has
More informationMODERN MANAGEMENT OF HYPERTENSION Where Do We Draw the Line? Disclosure. No relevant financial relationships. Blood Pressure and Risk
MODERN MANAGEMENT OF HYPERTENSION Where Do We Draw the Line? Disclosure No relevant financial relationships Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine baron@medicine.ucsf.edu
More informationHypertension and Atrial Fibrillation
Hypertension and Atrial Fibrillation Sheldon Tobe MD, MScCH (HPTE), FRCPC, FACP, FASH Hypertension and Nephrology HSF/NOSM Chair in Aboriginal and Rural Health Research Professor in Medicine, University
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 informationThe earlier BP control the better cardiovascular outcome. Jin Oh Na Cardiovascular center Korea University Medical College
The earlier BP control the better cardiovascular outcome Jin Oh Na Cardiovascular center Korea University Medical College Index Introduction HOPE-3 Trial Sprint Study Summary Each 2 mmhg decrease in SBP
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 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 Putting the Guidelines into Practice
Hypertension 2017 Putting the Guidelines into Practice 2017-09-08 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any
More informationHypertension: What s new since JNC 7. Harold M. Szerlip, MD, FACP, FCCP, FASN, FNKF
Hypertension: What s new since JNC 7 Harold M. Szerlip, MD, FACP, FCCP, FASN, FNKF Disclosures Spectral Diagnostics Site investigator Eli Lilly Site investigator ACP IM ITE writing committee NBME Step
More informationEvolving Concepts on Hypertension: Implications of Three Guidelines (JNC 8 Panel, ESH/ESC, NICE/BSH)
Evolving Concepts on Hypertension: Implications of Three Guidelines (JNC 8 Panel, ESH/ESC, NICE/BSH) Sidney C. Smith, Jr. MD, FACC, FAHA, FESC Professor of Medicine/Cardiology University of North Carolina
More informationManagement of Hypertension in Women
Management of Hypertension in Women Eliseo J. Pérez-Stable MD Professor of Medicine DGIM, Department of Medicine July 1, 2013 Declaration of full disclosure: No conflict of interest (I have never been
More informationRationale for the use of Single Pill Combination. Yong Jin Kim, MD Seoul National University Hospital
Rationale for the use of Single Pill Combination Yong Jin Kim, MD Seoul National University Hospital Unmet Need of Hypertension Treatment Hypertension # 1 Risk Factor for Global Mortality 0 1 2 3 4 5 6
More informationMANAGEMENT OF HYPERTENSION: TREATMENT THRESHOLDS AND MEDICATION SELECTION
Management of Hypertension: Treatment Thresholds and Medication Selection Robert B. Baron, MD MS Professor and Associate Dean Declaration of full disclosure: No conflict of interest Presentation Goals
More informationHypertension Controversies: SPRINTing to New Goals
Hypertension Controversies: SPRINTing to New Goals Diana Isaacs, PharmD, BCPS, BC-ADM, CDE Clinical Pharmacy Specialist Cleveland Clinic Lauren Wolfe, PharmD Primary Care Clinical Specialist Cleveland
More informationModule 2. Global Cardiovascular Risk Assessment and Reduction in Women with Hypertension
Module 2 Global Cardiovascular Risk Assessment and Reduction in Women with Hypertension 1 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored,
More informationHypertension JNC 8 (2014)
Hypertension JNC 8 (2014) Renewed: February 2018 Updated: February 2015 Comparison of Seventh Joint National Committee (JNC 7) vs. Eighth Joint National Committee (JNC 8) Hypertension Guidelines Methodology
More 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 informationHypertension in Geriatrics. Dr. Allen Liu Consultant Nephrologist 10 September 2016
Hypertension in Geriatrics Dr. Allen Liu Consultant Nephrologist 10 September 2016 Annual mortality (%) Cardiovascular Mortality Rates are Higher among Dialysis Patients 100 10 1 0.1 0.01 0.001 25-34
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 informationHypertension Putting the Guidelines into Practice
Hypertension 2018 Putting the Guidelines into Practice Ally P.H. Prebtani Professor of Medicine Internal Medicine, Endocrinology & Metabolism McMaster University Canada Faculty: Metabolism, Faculty Disclosure
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 informationWhat s In the New Hypertension Guidelines?
American College of Physicians Ohio/Air Force Chapters 2018 Scientific Meeting Columbus, OH October 5, 2018 What s In the New Hypertension Guidelines? Max C. Reif, MD, FACP Objectives: At the end of the
More 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 informationHypertension: Update
Hypertension: Update Meenakshi A Bhalla MD,FACC Associate Professor of Medicine Director Preventive Cardiology Advanced Heart Failure and Transplant Cardiology University of Kentucky Faculty Disclosure
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 informationBlood pressure treatment target in diabetes. Should it be <130 mmhg?
Blood pressure treatment target in diabetes Should it be
More informationRationale for the use of Single Pill Combination (SPC) and Asian data of ARB/CCB SPC
Rationale for the use of Single Pill Combination (SPC) and Asian data of ARB/CCB SPC Seung Woo Park, MD Samsung Medical Center BP Control Rates in Asia BP controlled BP uncontrolled 24.3% 36.6% 19% Turkey
More informationState of the art treatment of hypertension: established and new drugs. Prof. M. Burnier Service of Nephrology and Hypertension Lausanne, Switzerland
State of the art treatment of hypertension: established and new drugs Prof. M. Burnier Service of Nephrology and Hypertension Lausanne, Switzerland First line therapies in hypertension ACE inhibitors AT
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 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 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 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 informationMetabolic Consequences of Anti Hypertensives: Is It Clinically Important?
Metabolic Consequences of Anti Hypertensives: Is It Clinically Important?,FACA,FICA,MASH,FVBWG,MISCP CONSULTANT OF CARDIOLOGY DIRECTOR OF PORT-FOUAD HOSPITAL CCU Consideration of antihypertensive agents
More informationTalking about blood pressure
Talking about blood pressure Mrs Khan 56 BP 158/99 BMI 32 Total cholesterol 5.4 (HDL 0.8) HbA1c 43 She has been promising to do more exercise and eat more healthily for the last 2 years but her weight
More informationObjective & Outline. How the JNC Process Has Evolved. Expertise Represented on JNC 8 Panel
Implementation: Joint National Committee on High Blood Pressure JNC 8 Joel Handler, MD Kaiser Permanente Care Management Institute Hypertension Lead Southern California Permanente Group Objective & Outline
More 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 informationAdult Blood Pressure Clinician Guide June 2018
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Adult Blood Pressure Clinician Guide June 2018 Adult Blood Pressure Clinician Guide June 2018 Introduction This Clinician Guide is based on the 2018
More informationHypertension Management Focus on new RAAS blocker. Disclosure
Hypertension Management Focus on new RAAS blocker Rameshkumar Raman M.D Endocrine Associates of The Quad Cities Disclosure Speaker bureau Abbott, Eli Lilly, Novo Nordisk, Novartis, Takeda, Merck, Solvay
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 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 informationDEPARTMENT OF GENERAL MEDICINE WELCOMES
DEPARTMENT OF GENERAL MEDICINE WELCOMES 1 Dr.Mohamed Omar Shariff, 2 nd Year Post Graduate, Department of General Medicine. DR.B.R.Ambedkar Medical College & Hospital. 2 INTRODUCTION Leading cause of global
More information