Colin Edwards. Cardiologist Auckland Heart Group Waitemata Health
|
|
|
- Byron Ralf Henry
- 6 years ago
- Views:
Transcription
1 Colin Edwards Cardiologist Auckland Heart Group Waitemata Health August 2011
2 BP MEASUREMENTS measured seated mean of 2 or BP recordings at least 2 visits 2 x risk of developing true hypertension
3 Size of problem: 20% of adults in Western societies have hypertension Accounts for 1 in 6 deaths 95% is essential hypertension
4 Trials 35-40% mean reduction in stroke 20-25% reduction in MI 50% reduction in heart failure Pt with BP 159/95 mmhg (stage 1) on treatment for 10 yrs 12mmHg prevent 1 death for every 11 pts reated
5 GP Referral 63 year old female patient, retired secretary, married Known coronary artery disease and peripheral vascular disease CV Risks: longstanding mild hypertension treated dyslipidemia ex-smoker ACUTE PROBLEM: acceleration of hypertension x 6months poor control despite 3 agents more breathless- struggling to finish 18 holes of golf
6 Stable Coronary Artery Disease at present: Unstable angina- PCI (2000) NSTEMI-RCA PCI (2002) NSTEMI severe proximal RCA-DES (2006) Peripheral Vascular Disease: PCI L iliac artery 2002
7 Cilazapril 5mg/d Metoprolol 23.75mg/d Amlodipine 5mg/d Lipitor 80mg/d- TC- 4.8mmol/l, HDL- 0.9 mmol/l, LDL- 2.8 mmol/l, TG-2.4 mmol/l Compliance prefer not to be on medication; occasionally forgets Resveritrol, 3 oil, and glucosamine- takes religiously
8 First diagnosed at age 40 years Mother was a bad hypertensive- RIP stroke at 65 yrs Normal BP control through 3 pregnancies in her late 20 s Enjoys salty snacks after golf- 19 th hole Alcohol- wine every night with evening meal- 1-2 glasses 1 or 2 drinks after golf No liquorice liquor Exercise- 2 rounds of golf per week Uses Voltaren 75mg before golf bad back No HRT No hx of malignant phase ht, renal failure or heart failure STRESS?? work, financial, leaky home, son divorce etc...
9 Appeared a little anxious BMI-30 BP-190/110mmHg; PR-90 bpm Fundi- arteriolar narrowing Heart sounds- S4, S1, S2 no CHF Abdomen- peri-umbilical bruit bruits over both femoral arteries ECG- SR (p-mitrale), inferior Q waves, LV voltages + lateral strain pattern Creatinine-63umol/l, K+ 4.8mmol/l Fasting glucose-5.8mmol/l Urine-+proteinuria Thyroid functions-normal
10 45/48 interpretable measurements >95% 24 hour mean-168/93 mmhg (normal <135/85mmHg) non-dipper - minimal drop (6%) in nocturnal BP measurements
11 Significant hypertension- possibly resistant 3 anti-hypertensive agents- no diuretic, low doses of meds?compliance; NSAID; salty snacks; BMI End organ involvement-lvh, CAD, PVD, proteinuria Acceleration of hypertension x 6months? Secondary-RAS Loss of nocturnal dipping Para-umbilical bruit Vasculopath- stable coronary disease peripheral vascular disease
12 VOLUME EXPANSION: Vasodilators (ACE and Amlodipine)-lead to fluid retention OR volume expansion due to efferent arteriolar dilatation. Add low dose diuretic e.g. Inhibace plus
13
14 Study began 1994 x 8yrs pts Aim:? Best drug to start Rx. Results: SBP -greatest with chlorthalidone Less CHF with chlorthalidone JNC VII- start with diuretic Hypertension 2006
15 Aim: Optimal combination Rx for ht Compared the effects of two combinations AML/ACE or HCTZ/ACE on major fatal and nonfatal cardiovascular events men and women 55 years or older who had SBP >160 mm Hg RESULTS: 20% in morbidity and mortality in AML/ACE group.?jnc-7 revision
16 HYVET- benefits and risks of reducing BP (SBP>160mmHg) in very elderly hypertensives. (aged 80 or more). BP lowering benefits could be offset by harm due to hypotension-related syncope patients, international trial 11 different countries Followed for 2 years Elderly pts are prone to postural hypotension Monitor/measure BP s in the standing position RESULT: Treatment of hypertension Stroke 30% Mortality 21% Heart failure 64%
17
18 Inhibace Plus 1 daily Amlodipine 10 mg/d Metoprolol 47.5 mg/d Office BP 170/95mmHg Home Monitoring: Most levels elevated mmHg Home Monitoring: Encourage purchasing of unit Keep a diary to bring to clinic- NEED AT LEAST 12 MEASUREMENTS 2-3 readings per week, at rest, sitting. Normal <135/85mmHg Helps me adjust and uptitrate therapy Engages the patient- encourages and motivates pts to remain compliant
19 Right kidney-10cm; good cortical thickness Left kidney 11cm; good cortical thickness 85% STENOSIS- ORIGIN OF RIGHT RENAL ARTERY Resistive Index % STENOSIS- ORIGIN OF LRA. Serum Cr: 63umol/l Urine: + proteinuria Refractory hypertension- 4 agents Probably has renal ischaemia, but still has good residual renal function.
20 Renal perfusion activation of juxta-glomerular cells Release of renin
21 Improve renal perfusion
22 2 trials ASTRAL (806 PTS), STAR(140 pts) -Endpoints-renal function, CV events, mortality -No benefit of stenting plus medical therapy over medical therapy alone -Limited by imprecise definitions of RAS, inclusion of pts with insignificant lesions, crossovers, multiple disease etc. CORAL- well designed multi-centre study. completion expected 2011 meantime revascularisation should be reserved for pts in whom aggressive medical therapy fails, trial participants.
23 Urine: + proteinuria Serum Cr- 64umol/l
24
25 On 4 medications plus renal artery stenting- 24 hr average of 154/88mmHg Need Better Treatments Direct Renin Inhibitor e.g. Aliskiren ACE Inhibitors Angiotensin Receptor blockers e.g. Losartan, candesartan
26 Circulation.2009;119:
27
28 Take a good history- compliance, diet (salt), stress, alcohol, NSAID s Resistant hypertension- persistent ht despite good doses of 3 agents including a diuretic- ACE/ARB, Ca blocker, thiazide diuretic refer Need a good diuretic e.g. Chlorthalidone 25mg/d egfr <40mls/min Frusemide bd Maximise doses of ACE/ARB, calcium blockers If overweight- spironolactone 25mg/d Look at heart rate- good indicator of sympathetic activity B-Blocker Diltiazem with the amlodipine
29 Benefit in treating hypertension in the very elderly (HYVET) BP Target are lower- SBP-150mmHg Postural hypotension- monitor Rx in the standing position Promote home BP monitoring-engages the pt and improves compliance 24 hour BP monitoring in useful Useful information on nocturnal BP-dippers, non-dippers and risers
30
Colin Edwards. Cardiologist Auckland Heart Group Waitemata Health
Colin Edwards Cardiologist Auckland Heart Group Waitemata Health AUG 2012 Introduction Case Summary BP MEASUREMENTS measured seated mean of 2 BP recordings per visit at least 2 visits Diet Exercise Weight
Management of Hypertension and Consequences of non-compliance. Colin Edwards
Management of Hypertension and Consequences of non-compliance Colin Edwards CARDIOLOGIST AHG May 2016 Outline 1. Consequences of poorly controlled hypertension 2. BP targets and anti-hypertensive drugs
HYPERTENSION CHAT with Colin and Ted AUG 2015
HYPERTENSION CHAT with Colin and Ted AUG 2015 INTRODUCTION Hypertension has challenged famous physicians for centuries. 1733 - Clergyman Stephen Hales made the 1 st published measurement of blood pressure
The State of Hypertension in NZ in 2010 personal view
The State of Hypertension in NZ in 2010 personal view Patient referred to medical clinic Dear Dr, Please see this man with resistant hypertension 50 year old European male Blood Pressure on current meds
Preventing 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
Update 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
Managing 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
MANAGEMENT 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
Hypertension 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
Modern 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
HYPERTENSION. Introduction. Colin Edwards Cardiologist AHG and WDHB
HYPERTENSION Introduction Colin Edwards Cardiologist AHG and WDHB June 2014 Disclosures FIONA STEWART Advisory Board Pfizer, AstraZeneca Meetings - AstraZeneca, MSD COLIN EDWARDS Meetings - AstraZeneca
ADVANCES 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%
Modern 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
Hypertension 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.
HYPERTENSION 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
4/4/17 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
ADVANCES 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,
New 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
Hypertension 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
Management of Hypertension
Clinical Practice Guidelines Management of Hypertension Definition and classification of blood pressure levels (mmhg) Category Systolic Diastolic Normal
Management 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
MODERN 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
Hypertension 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
CKD & HT. Anne-Marie Angus
CKD & HT Anne-Marie Angus Hypertension definitions Persisting BP >140/90 and HBPM >135/85 Stage 1 >140/90 (HBPM >135/85) Stage 2 >160/100 (HBPM >150/90) Severe >180/100 White coat HT Why treat? A major
Management 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
Hypertension 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
Treating Hypertension from
Treating Hypertension from Initiation to Resistance: A Case Study Approach Michelle Krause, MD Division of Nephrology University of Arkansas for Medical Sciences Central Arkansas Veteran s Healthcare System
DISCLOSURES 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
Managing 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
Managing 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
Patrick Kay, General and Interventional Cardiologist Auckland or healthpoint.co.nz
Patrick Kay, General and Interventional Cardiologist Auckland ipatkay@hotmail.com or healthpoint.co.nz Rotorua 2015 Rotorua 2015 Graphical example of true mean and variation, and of regression to the
Module 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,
Antihypertensive drugs: I. Thiazide and other diuretics:
Clinical assessment of hypertensive patient: You have to take history regarding the presence of other risk factors for CAb like diabetes mellitus, smoking, etc. Take history whether the patient takes medications
DISCLOSURE 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
Difficult 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
Hypertension 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
Hypertension 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
Hypertension 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
ANTI-THROMBOTIC THERAPY in NON-VALVULAR ATRIAL FIBRILLATION
ANTI-THROMBOTIC THERAPY in NON-VALVULAR ATRIAL FIBRILLATION Colin Edwards Auckland Heart Group Waitemata Health June 2015 PFIZER Lecture series Disclosures EPIDEMIOLOGY Atrial fibrillation is the most
Coral Trials: A personal experience that challenges its results in patients with uncontrolled blood pressure.
Coral Trials: A personal experience that challenges its results in patients with uncontrolled blood pressure.. Dr. Javier Ruiz Aburto, FACS, FICS Assistant Professor Ponce School of Medicine Puerto Rico
7/7/ 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
Pharmacologic Management of Hypertension
Current Concepts In Management of Fernando Vega, MD Secondary - Definition Renovascular Disease (The kidney doesn t get impressed by blood pressure) Renovascular stenosis Renal artery stenosis Fibromuscular
Hypertension 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
Hypertension 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
Diversity and HTN: Approaches to optimal BP control in AfricanAmericans
Diversity and HTN: Approaches to optimal BP control in AfricanAmericans Quinn Capers, IV, MD, FACC, FSCAI Assistant Professor of Medicine Associate Dean for Admissions Do Racial Differences Really Exist
Cardiac Pathophysiology
Cardiac Pathophysiology Evaluation Components Medical history Physical examination Routine laboratory tests Optional tests Medical History Duration and classification of hypertension. Patient history of
Hypertension 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
JNC 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
Incidental 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
DEPARTMENT 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
Antihypertensive 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
Objectives. 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
Cardiovascular Health Practice Guideline Outpatient Management of Coronary Artery Disease 2003
Authorized By: Medical Management Guideline Committee Approval Date: 12/13/01 Revision Date: 12/11/03 Beta-Blockers Nitrates Calcium Channel Blockers MEDICATIONS Indicated in post-mi, unstable angina,
Younger adults with a family history of premature artherosclerotic disease should have their cardiovascular risk factors measured.
Appendix 2A - Guidance on Management of Hypertension Measurement of blood pressure All adults from 40 years should have blood pressure measured as part of opportunistic cardiovascular risk assessment.
Evaluation 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
STANDARD treatment algorithm mmHg
STANDARD treatment algorithm 130-140mmHg (i) At BASELINE, If AVERAGE SBP 1 > 140mmHg If on no antihypertensive drugs: Start 1 drug: If >55 years old / Afro-Caribbean: Calcium channel blocker (CCB) 2 If
Treating 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
The Failing Heart in Primary Care
The Failing Heart in Primary Care Hamid Ikram How fares the Heart Failure Epidemic? 4357 patients, 57% women, mean age 74 years HFSA 2010 Practice Guideline (3.1) Heart Failure Prevention A careful and
What 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
Approach 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,
Hypertension 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,
Hypertension 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
ALLHAT. 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
Hypertension 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,
Hypertension 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
Management of Hypertension for Stroke Prevention in New Zealand: Can We Do Better? Walter van der Merwe Nephrologist Waitemata DHB
Management of Hypertension for Stroke Prevention in New Zealand: Can We Do Better? Walter van der Merwe Nephrologist Waitemata DHB Increasing stroke numbers in New Zealand an 'epidemic' says leading AUT
How do we diagnose hypertension today? Presentation Subtitle
How do we diagnose hypertension today? Presentation Subtitle Renata Cífková Case 1 JM, a 64-year-old lady referred to our center because of undesirable effects of her antihypertensive medication Personal
The 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
Creative 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
Byvalson. (nebivolol, valsartan) New Product Slideshow
Byvalson (nebivolol, valsartan) New Product Slideshow Introduction Brand name: Byvalson Generic name: Nebivolol, valsartan Pharmacological class: Beta-blocker + angiotensin II receptor blocker (ARB) Strength
How Low Do We Go? Update on Hypertension
How Low Do We Go? Update on Beth L. Abramson, MD, FRCPC, FACC As presented at the University of Toronto s Saturday at the University Session (September 2003) Arecent World Health Organization report states
Treating 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
Jared 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
5.2 Key priorities for implementation
5.2 Key priorities for implementation From the full set of recommendations, the GDG selected ten key priorities for implementation. The criteria used for selecting these recommendations are listed in detail
Management 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
CVD Risk of Hypertension. Regina Giblin CVD Clinical Development Coordinator
CVD Risk of Hypertension Regina Giblin CVD Clinical Development Coordinator CVD Clinical Development Coordinator In-house education for your team: Regina Giblin giblinr@bhf.org.uk Often interactive with
JNC Evidence-Based Guidelines for the Management of High Blood Pressure in Adults
JNC 8 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults Table of Contents Why Do We Treat Hypertension? Blood Pressure Treatment Goals Initial Therapy Strength of Recommendation
Clinical 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
Management 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
By 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
LXIV: DRUGS: 4. RAS BLOCKADE
LXIV: DRUGS: 4. RAS BLOCKADE ACE Inhibitors Components of RAS Actions of Angiotensin i II Indications for ACEIs Contraindications RAS blockade in hypertension RAS blockade in CAD RAS blockade in HF Limitations
APPENDIX 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
This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data.
abcd Clinical Study Synopsis for Public Disclosure This clinical study synopsis is provided in line with s Policy on Transparency and Publication of Clinical Study Data. The synopsis which is part of the
Hypertension in the Era of ACC/AHA: Practice Changing Evidence and Recommendations
Hypertension in the Era of ACC/AHA: Practice Changing Evidence and Recommendations Gerald W. Smetana, M.D., MACP Division of General Medicine Beth Israel Deaconess Medical Center Professor of Medicine
Difficult-to-Control & Resistant Hypertension. Anthony Viera, MD, MPH, FAHA Professor and Chair
Difficult-to-Control & Resistant Hypertension Anthony Viera, MD, MPH, FAHA Professor and Chair Objectives Define resistant hypertension Discuss evaluation strategy for patient with HTN that appears difficult
CARDIOVASCULAR RISK FACTORS & TARGET ORGAN DAMAGE IN GREEK HYPERTENSIVES
CARDIOVASCULAR RISK FACTORS & TARGET ORGAN DAMAGE IN GREEK HYPERTENSIVES C. Liakos, 1 G. Vyssoulis, 1 E. Karpanou, 2 S-M. Kyvelou, 1 V. Tzamou, 1 A. Michaelides, 1 A. Triantafyllou, 1 P. Spanos, 1 C. Stefanadis
Medical 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
COMPLEX HYPERTENSION. Anita Ralstin, FNP-BC Next Step Health Consultant, LLC
COMPLEX HYPERTENSION Anita Ralstin, FNP-BC Next Step Health Consultant, LLC Incidence Of Hypertension About 70 million American adults have high blood pressure. About 33% of the population Only 52% have
Hypertension Update. Objectives 4/28/2015. Beverly J. Mathis, D.O. OOA May 2015
Hypertension Update Beverly J. Mathis, D.O. OOA May 2015 Objectives Learn new recommendations for BP treatment goals Approach to hypertension in the office Use of hypertensive drugs, and how to tailor
University of Al Qadisiyah College of Pharmacy Dr. Bassim I Mohammad, MBChB, MSc, Ph.D
University of Al Qadisiyah College of Pharmacy Dr. Bassim I Mohammad, MBChB, MSc, Ph.D Cardiovascular Pharmacology 1. Antihypertensives 2. Antianginal 3. Drugs for HF 4. Antiarrythemics 5. Drugs for Hyperlipoproteniemia
Randomized Design of ALLHAT BP Trial
Outcomes in Hypertensive Black and Nonblack Patients Treated with Chlorthalidone, Amlodipine, and Lisinopril* *Wright JT, Dunn JK, Cutler JA et al. JAMA 2005:293:1595-1608. 42,418 High-risk hypertensive
Macrovascular Residual Risk. What risk remains after LDL-C management and intensive therapy?
Macrovascular Residual Risk What risk remains after LDL-C management and intensive therapy? Defining Residual Vascular Risk The risk of macrovascular events and microvascular complications which persists
Reframe the Paradigm of Hypertension treatment Focus on Diabetes
Reframe the Paradigm of Hypertension treatment Focus on Diabetes Paola Atallah, MD Lecturer of Clinical Medicine SGUMC EDL monthly meeting October 25,2016 Overview Physiopathology of hypertension Classification
The real picture. Prorenin (Renin) PRR AT3 AT4. AT4 receptor. PAI 1 Abassi, Biochem Pharm, 2009
The real picture. Prorenin (Renin) PRR AT3-8 AT4 AT10-12 AT3 AT4 receptor PAI 1 Abassi, Biochem Pharm, 2009 Resistant Hypertension; Case based discussion Moving Targets? RAAS blockade in hypertensive CKD
Adult 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
Overview. NOT A REPETION OF LOCAL GUIDELINE Dr Diviash Thakrar
Overview 1. Why hypertension is important? 2. What are basic principles in treatment? 3. Different ways of measuring 4. Hypercholesterolemia NOT A REPETION OF LOCAL GUIDELINE CVD risk factors? Non modifiable
Talking 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
Clinical Recommendations: Patients with Periodontitis
The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease. Friedewald VE, Kornman KS, Beck JD, et al. J Periodontol 2009;
Life After CORAL: What Did CORAL Prove? David Paul Slovut, MD, PhD Co-director TAVR, Dir of Advanced Intervention
Life After CORAL: What Did CORAL Prove? David Paul Slovut, MD, PhD Co-director TAVR, Dir of Advanced Intervention No Relationships to Disclose The Need for Modern Renal Trials Increased rate of RAS diagnosis