Obesity and Hypertension. Manish Sinha Evelina London Children s Hospital
|
|
- Scott Hill
- 5 years ago
- Views:
Transcription
1 Obesity and Hypertension Manish Sinha Evelina London Children s Hospital Manchester 30 th June 2017
2 Scope of Talk Trends of childhood obesity in the UK Prevalence of hypertension in obese children Pathophysiology of hypertension in obesity Relevance does it matter during childhood and as young adults with childhood onset obesity Cases from our hypertension clinic
3 Definition of obesity - BMI There are several definitions around for overweight and obesity Clinical cut-offs - 85 th and 95 th percentile Health policy - 91 st and 98 th percentile (NICE/ DoH) International Obesity Task force (IOTF) - 88 th /90 th and 99 th corresponds with adult BMI cut offs at 25 kg/m 2 and 30 kg/m 2
4
5 Prevalence of overweight and obesity by study year and age group in boys and girls Cornelia H M van Jaarsveld, and Martin C Gulliford Arch Dis Child 2015;100:
6 Trends in childhood obesity Stabilising of the prevalence of childhood overweight and obesity similar trends in the US, Netherlands and Australia Reasons in the UK public health campaigns <11 year olds Physical Education in schools Active School Travel policies
7 Prevalence of obesity by study year and age group in boys and girls Cornelia H M van Jaarsveld, and Martin C Gulliford Arch Dis Child 2015;100:
8 and how common is hypertension in obese children?
9 Prevalence of hypertension and prehypertension in US (NHANES) Hypertension: SBP and/or DBP on 3 occasions 95 th percentile Prevalence 1-2%, age 8-17 Prehypertension: SBP and/or DBP 90 th percentile, < 95 th percentile or BP >120/80 mmhg Prevalence about 5% age % age 13-17
10 Prevalence of hypertension and prehypertension in US (NHANES) JAMA Pediatr. 2015;169(3): doi: /jamapediatrics
11 Hypertension in obese children-2 Sorof J et al. J Pediatr. 2002; 140:
12 Obese children display clustering of cardiometabolic risk factors In a cohort of n=611 obese youth hyperinsulinism (30.8%), lipid abnormalities (12.9%) and high BP (10.5%) in addition to obesity, one risk factor was present in 39%, two risk factors in 16.5% and three risk factors in 2.8% Blood pressure in children and adolescents: current insights. Lurbe, Empar; Ingelfinger, Julie Journal of Hypertension. 34(2): , 2016.
13 Major issue - several OTHER problems Type 2 diabetes mellitus Dyslipidaemia Non-alcoholic fatty liver (steatohepatitis) Obstructive sleep apnea Orthopaedic problems
14 Frequency of systolic and diastolic hypertension ISH (SBP ³140 mm Hg and DBP <90 mm Hg) SDH (SBP ³140 mm Hg and DBP ³90 mm Hg) IDH (SBP <140 mm Hg and DBP ³90 mm Hg) % 16% 16% 20% 20% 11% < Age Franklin et al. Hypertension 2001;37:
15 Frequency of systolic and diastolic hypertension ISH (SBP ³140 mm Hg and DBP <90 mm Hg) SDH (SBP ³140 mm Hg and DBP ³90 mm Hg) IDH (SBP <140 mm Hg and DBP ³90 mm Hg) % 16% 16% 20% 20% 11% < Age Sorof et al. J Pediatr 2002;140: Franklin et al. Hypertension 2001;37:
16 Pathophysiology - 1 Blood pressure - balance between CO and peripheral resistance In adults - CO maintained but peripheral resistance goes up as arterioles have smooth muscle cells
17 Mechanisms that link obesity with peripheral vascular resistance Autonomic nervous system activation Renal mechanisms: impaired pressure natriuresis; RAS Hormones: insulin resistance, Leptin Endothelial dysfunction: a state of inflammation Pathophysiology - 2
18 Summary-1 Excess weight including obesity remain highly prevalent and continue to rise in those >11 years absence of any specific long term programme Hypertension in obesity is common but only one of several CV risk factors present in this cohort Often asymptomatic and this makes it difficult for the patient to understand no national blood pressure measurement programmes Pathophysiology of hypertension in obese children is poorly understood few recent data
19 Do obese hypertensive children exhibit TOD? Obesity increased clustering of CV risk factors Increased carotid intima medial thickness (cimt) and LVH described in children with essential hypertension cimt and LV mass correlate with blood pressure and BMI elevated BMI, SBP and serum triglyceride and LDL-C Berenson GS et al. N Engl J Med 1998;338:
20 The Journal of Clinical Hypertension Volume 18, Issue 7, pages
21
22 Value of current BMI and BP? Normal BMI and blood pressure tracks during childhood tracking Probability of overweight at age 35 y predicted from childhood BMI at the 95th percentile Similarly, abnormal BMI and BP have been shown to increase to higher percentiles over time Guo S S, and Chumlea W C Am J Clin Nutr 1999;70:145s- 148s
23 Value of current BP SBP and DBP tracking correlation coefficients against follow-up period Xiaoli Chen, and Youfa Wang Circulation. 2008;117: Copyright American Heart Association, Inc. All rights reserved.
24 Childhood Adiposity, Adult Adiposity, and Cardiovascular Risk Factors Juonala M et al. N Engl J Med 2011;365: Four prospective cohort studies Bogalusa Heart Study (BOGA) Muscatine Study (MUSC) Childhood Determinants of Adult Health (CDAH) study Cardiovascular Risk in Young Finns Study (YFS)
25
26
27 From: Isolated Systolic Hypertension in Young and Middle-Aged Adults and 31-Year Risk for Cardiovascular Mortality: The Chicago Heart Association Detection Project in Industry Study J Am Coll Cardiol. 2015;65(4): doi: /j.jacc Figure Legend: Hypertension Subtype and Cardiovascular Mortality: Kaplan-Meier Curves of the Cumulative Incidence of CVD Mortality by Sex Sex-specific cumulative incidence rate of cardiovascular disease (CVD) mortality for each hypertension subtype is shown. The definition of each color line is as follows: periwinkle, systolic diastolic hypertension (systolic blood pressure [SBP] 140 mm Hg and diastolic blood pressure [DBP] 90 mm Hg); gold, isolated diastolic hypertension (SBP <140 mm Hg and DBP 90 mm Hg); violet, isolated systolic hypertension (SBP 140 mm Hg and DBP <90 mm Hg); green, high-normal blood pressure (BP) (SBP 130 to 139 Date mmof Hg download: and DBP 85 to 89 mm Hg, SBP 130 Copyright to 139 mm The Hg American and DBP <85 College mm Hg, of Cardiology. or SBP <130 mm Hg and DBP 85 to 89 mm Hg); 5/25/2015 salmon, optimal-normal BP (SBP <130 mm Hg and DBP All <85 rights mm reserved. Hg). The log-rank was used to calculate p values. IDH = isolated diastolic hypertension; ISH = isolated systolic hypertension; SDH = systolic diastolic hypertension.
28 Summary-2 Current BMI and BP levels - track and predict There is strong association of obesity and hypertension with surrogate markers of CV disease during childhood and Young obese adults with childhood onset obesity display the highest risk of developing CV risk factors Emerging longitudinal data regarding CV mortality related to elevated BP levels in young adults
29 Tertiary One stop hypertension clinic for service evaluation at ELCH of since June 2009 hypertension in children - single visit 90% with normal renal function Family history & investigation work-up completed Out of office evaluation including interpretation of results dietary assessment for salt and calories 24-hour urine specimen for measurement of sodium cardiac (and vascular) assessment monitoring following commencement of therapy shared care management 29
30 Tertiary clinic-2 The service is now well established with over 450 patients seen in the past 7-years see new referrals per year Patients being referred from primary, secondary primary care - General Practitioners - rarely secondary care Consultant Paediatricians majority tertiary care Consultant sub-specialists (cardiologist, endocrine) What are their age ranges? 14% <2years; 11% 2-5 years; 75% >5years
31 Case 1 DO 12 year old boy, african origin - headaches & chest pain No cardiac cause identified hence referred to the clinic cm (2 nd -9 th percentile) and 42.7 kg (75 th percentile) BMI 23.2 kg/m 2 (95 th percentile) clinical excess weight 126/78 mmhg clinic (95 th percentile 119/78) - confirmed on ambulatory BP 126/67 mmhg - ISH concentric LVH with increased microalbuminuria 7g of sodium in 24-hour urine specimen
32 Case 1 DO Future management Commenced on amlodipine whilst actively modifying lifestyle & diet 12 months later BP 112/70 mmhg asymptomatic but now performing regular physical exercise cm and 46kg - BMI 24.0 kg/m 2 (97 th percentile) Very few snacks - 5g equivalent of sodium in 24- hour urine LVMI improved 44 g/m 2.7
33 Normal blood pressure values for boys Height percentile 50 th 75 th 90 th 95 th 12 year 95 th BP percentile 13 year 95 th BP percentile 123/81 125/82 127/82 127/83 126/81 128/82 129/83 130/83
34
35
36 Staging of Hypertension Stage 1: 95 th 99 th percentile Stage 2: >99 th percentile +5mmHg Clinical urgency symptomatic or incidental finding? Life threatening hypertension 36
37 Improve clinical practice - 1 Must measure BP in children >3 years Copies of the normal BP tables in boys and girls from the Fourth report, should be available to all clinicians in clinic rooms Cardio Z iphone app from ELCH calculation of a user-defined 'target centile' blood pressure
38 Case 1 DO 2017 Ongoing weight gain and ill-sustained lifestyle changes Amlodipine and Lisinopril 4 years later BP 130/72 mmhg asymptomatic cm and 62.8kg - BMI 26.9 kg/m 2 (98 th percentile) - no change few snacks on history Increased indexed LV mass 65.6 g/m 2.7 ; concentric LVH
39 Case 2 NW 16 years 2 monh old boy, african origin feels unwell, headache 177 cm (25 th -50 th percentile) and 75 kg; BMI: 23.9 kg/m 2 (92 nd percentile) - clinical excess weight 170/62 mmhg clinic; (95 th percentile 136/86) confirmed on ambulatory BP 142/64 mmhg - ISH 7.9g of sodium in 24-hour eccentric LVH with increased microalbuminuria
40 Case 2 NW Future management - 9 months later Initially on two but now on single agent - ACEi - BP 122/64 mmhg - asymptomatic Modified diet - no snacks, family modified diet
41
42
43 Case 3 PM 15 year old girl, Caucasian headaches and breathlessness High BP detected whilst on holiday cm (50 th percentile) and 96.2 kg BMI: 31.8 kg/m2 (99 th percentile) - obese 143/104 mmhg clinic; (95 th percentile 131/80) confirmed on ambulatory BP 142/68 mmhg - ISH 12.5g of sodium in 24-hour; normal renal function no evidence of LVH; indexed LV mass 26.8 g.m2.7
44 Case 3 PM Family history of hypertension and hypercholesterolaemia normal lipid profile Difficult to convince need to take medications will take medications for short period and stop once BP level better! Good response to medications but no weight improvement or change in diet
45 Daily recommended salt in children 1 to 3 years 2g salt a day (0.8g sodium) 4 to 6 years 3g salt a day (1.2g sodium) 7 to 10 years 5g salt a day (2g sodium) 11 years and over 6g salt a day (2.4g sodium) Food labels only give the figure for sodium Salt (mg)= sodium (mg) x 2.5
46 Salt intake and blood pressure Quanhe Yang et al. Pediatrics 2012;130:
47 Case 4 DA 15 year old boy, african origin asymptomatic High BP detected when joining gymnasium cm and kg BMI: 29.7 kg/m2 (99 th percentile) obese Hyperuricaemia and dyslipidaemia 159/77 mmhg clinic; confirmed on ambulatory BP 154/92 mmhg - SDH 11.5g of sodium in 24-hour; normal renal function Concentric LVH; indexed LV mass 46.6 g.m2.7 Commenced on Amlodipine with some improvement Felt better - so stopped medication and missed two appointments!
48 Weight (Kg) Blood pressure (mmhg) Case 4 DA Weight SBP DBP Re-presented with even worse BP 163/100 mmhg o asymptomatic cannot understand the fuss; weight 119.8kg Continuing poor adherence to diet and medication Transitioned to adults - no change o o o Age in years Asymptomatic; 132.1kg and increasing; BMI 99 th percentile Concentric LVH but with preserved biventricular systolic function On 3-anti-hypertensives (Amlodipine, Lisinopril and Hydrochorthiazide)
49 Case 5 JB 16 years 9 months boy, causcasian intermittent headaches High BP detected at the time of check entry to health club DGH - height (50 th -75 th centile) and weight 119 kg BMI 38.1 kg/m 2 (>99 th percentile) morbidly obese 160/86 mmhg - confirmed on ABPM 151/74 mmhg - ISH HTN clinic kg! and BP improved as well!! Clinic - 124/62 mmhg clinic; ambulatory BP 110/66 mmhg on no medication No evidence of LVH
50 Case 5 JB Future management Took up boxing 18 months later 83.5kg & very well - discharged Dynamap 143/71 but Aneroid measurements 112/68 mmhg
51 Management Non-pharmacological: weight reduction and exercise together most effective at least early (>6-month) compliance major issue target BMI <85 th percentile, 40-min exercise 3-5 days a week Diet need to cut down on salt intake This needs to be demonstrated to families often as convinced salt intake not high! Pharmacotherapy generally reserved for symptomatic hypertension +/- evidence of end-organ damage elevated BP unresponsive to conservative treatment 51
52 Summary-3 some findings from the hypertension clinic Isolated systolic hypertension 80%-85% males, adolescents, increased BMI and poor diet No identifiable cause renal, cardiac, other mostly asymptomatic; High salt intake and excessive sodium in 24-hour urine even in those with normal BMI In confirmed cases of hypertension less than a 1/3 rd have LVH (+/-micro Alb) often eccentric Most effective treatment measures that have improved BP Reduction of salt intake CCB, ACEi and diuretics in some 52
53 Acknowledgments Kings College London Guy s & St Thomas Charity British Heart Foundation 53
54 THANK YOU
Hypertension with Comorbidities Treatment of Metabolic Risk Factors in Children and Adolescents
Hypertension with Comorbidities Treatment of Metabolic Risk Factors in Children and Adolescents Stella Stabouli Ass. Professor Pediatrics 1 st Department of Pediatrics Hippocratio Hospital Evaluation of
More informationAdolescent Hypertension Roles of obesity and hyperuricemia. Daniel Landau, MD Pediatrics, Soroka University Medical Center
Adolescent Hypertension Roles of obesity and hyperuricemia Daniel Landau, MD Pediatrics, Soroka University Medical Center Blood Pressure Tables BP standards based on sex, age, and height provide a precise
More informationReference Values and Simplified Methods for Interpretation of Blood Pressure in Children and Adolescents
Reference Values and Simplified Methods for Interpretation of Blood Pressure in Children and Adolescents Simonetti G.D. Istituto Pediatrico della Svizzera Italiana Ente Ospedaliero Cantonale e Università
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 informationDr Doris M. W Kinuthia
Dr Doris M. W Kinuthia Objectives Normal blood pressures in children Measurement of blood pressure in children Aetiology of Hypertension in children Evaluation of children with hypertension Treatment of
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 informationFructose, Uric Acid and Hypertension in Children and Adolescents
Fructose, Uric Acid and Hypertension in Children and Adolescents Daniel I. Feig, MD, PhD, MS Director, Division of Nephrology Department of Pediatrics University of Alabama, Birmingham Topics for Discussion
More informationHypertension and obesity. Dr Wilson Sugut Moi teaching and referral hospital
Hypertension and obesity Dr Wilson Sugut Moi teaching and referral hospital No conflict of interests to declare Obesity Definition: excessive weight that may impair health BMI Categories Underweight BMI
More informationMetabolic Syndrome Across the Life Cycle - Adolescent. Joy Friedman MD
Metabolic Syndrome Across the Life Cycle - Adolescent Joy Friedman MD Disclosures I have no actual or potential conflict of interest in relation to this program or presentation. I will mention off-label
More informationAssessing Overweight in School Going Children: A Simplified Formula
Journal of Applied Medical Sciences, vol. 4, no. 1, 2015, 27-35 ISSN: 2241-2328 (print version), 2241-2336 (online) Scienpress Ltd, 2015 Assessing Overweight in School Going Children: A Simplified Formula
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 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 informationDiabetes and Hypertension
Diabetes and Hypertension M.Nakhjvani,M.D Tehran University of Medical Sciences 20-8-96 Hypertension Common DM comorbidity Prevalence depends on diabetes type, age, BMI, ethnicity Major risk factor for
More informationImportance of Ambulatory Blood Pressure Monitoring in Adolescents
Importance of Ambulatory Blood Pressure Monitoring in Adolescents Josep Redon, MD, PhD, FAHA Internal Medicine Hospital Clinico Universitario de Valencia University of Valencia CIBERObn Instituto de Salud
More informationmajor public health burden
HYPERTENSION INTRODUCTION Hypertension is one of the major public health burden in the recent times. Hypertension remains a challenging medical condition among the noncommunicable diseases of ever growing
More informationAdolescent Obesity GOALS BODY MASS INDEX (BMI)
Adolescent Obesity GOALS Lynette Leighton, MS, MD Department of Family and Community Medicine University of California, San Francisco December 3, 2012 1. Be familiar with updated obesity trends for adolescent
More informationDirector of the Israeli Institute for Quality in Medicine Israeli Medical Association July 1st, 2016
The differential effect of Atherosclerosis on end organ damage in adult and elderly patients with CVRF: New Algorithm for Hypertension Diagnosis and Treatment R. Zimlichman, FAHA, FASH, FESC, FESH Chief
More informationObjectives. Objectives. Alejandro J. de la Torre, MD Cook Children s Hospital May 30, 2015
Alejandro J. de la Torre, MD Cook Children s Hospital May 30, 2015 Presentation downloaded from http://ce.unthsc.edu Objectives Understand that the obesity epidemic is also affecting children and adolescents
More information2/11/2019 CLINICAL IMPLEMENTATION OF THE UPDATED BP GUIDELINES DUALITY OF INTEREST
CLINICAL IMPLEMENTATION OF THE UPDATED BP GUIDELINES George L. Bakris, M.D.,F.A.S.N., F.A.H.A. Professor of Medicine Director, Am Heart Assoc. Comprehensive Hypertension Center University of Chicago Medicine
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 informationReframe 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
More informationΑΡΥΙΚΗ ΠΡΟΔΓΓΙΗ ΤΠΔΡΣΑΙΚΟΤ ΑΘΔΝΟΤ. Μ.Β.Παπαβαζιλείοσ Καρδιολόγος FESC - Γιεσθύνηρια ιζμανόγλειον ΓΝΑ Clinical Hypertension Specialist ESH
ΑΡΥΙΚΗ ΠΡΟΔΓΓΙΗ ΤΠΔΡΣΑΙΚΟΤ ΑΘΔΝΟΤ Μ.Β.Παπαβαζιλείοσ Καρδιολόγος FESC - Γιεσθύνηρια ιζμανόγλειον ΓΝΑ Clinical Hypertension Specialist ESH Hypertension Co-Morbidities HTN Commonly Clusters with Other Risk
More informationCARDIOVASCULAR 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
More informationObjectives. JNC 7 Is Nice But What s Up With JNC 8? Why Do We Care? Hypertension Background: Prevalence
JNC 7 Is Nice But What s Up With JNC 8? 37 th Annual CAPA Conference October 4 th 2013 Ignacio de Artola, Jr. M.D. Assistant Professor of Clinical Family Medicine Medical Director, Primary Care Physician
More informationMPharmProgramme. Hypertension (HTN)
MPharmProgramme Hypertension (HTN) Slide 1 of 30 Overview Definition Prevalence Type Causes Diagnosis Management Patients perspective Slide 2 of 30 Definition It is not a disease! So what is it? What two
More informationDifficult-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
More informationThe Association of Pediatric Obesity with Nocturnal Non-Dipping on. 24-Hour Ambulatory Blood Pressure Monitoring. Ian Macumber.
The Association of Pediatric Obesity with Nocturnal Non-Dipping on 24-Hour Ambulatory Blood Pressure Monitoring Ian Macumber A thesis submitted in partial fulfillment of the requirements for the degree
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 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 informationTIP. Documentation and coding guide. Disease definitions* Prevalence and statistics associated with HTN**
Documentation and coding guide Disease definitions* HTN is diagnosed when the average of two or more (systolic of diastolic) blood pressure readings are found to be elevated on two or more office visits
More informationPediatric Hypertension. Alisa A. Acosta, MD, MPH Asst. Professor, Renal Section April 5, 2019
Pediatric Hypertension Alisa A. Acosta, MD, MPH Asst. Professor, Renal Section April 5, 2019 Objectives Recognize the importance of accurate blood pressure measurement in pediatric patients Define pediatric
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 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 informationBlood Pressure Measurement (children> 3 yrs)
Blood Pressure Measurement (children> 3 yrs) If initial BP elevated, repeat BP manually 2x and average, then classify Normal BP Systolic and diastolic
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 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 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 informationHypertension Guidelines 2017
Hypertension Guidelines 2017 (American College of Cardiology and the American Heart Association) In 1977, the 1st comprehensive guideline for detection, evaluation, and management of high BP was published,
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 informationManagement of Hypertension in special groups. DR-Mohammed Salah Assistant Lecturer of Cardiology Mansoura University
Management of Hypertension in special groups BY DR-Mohammed Salah Assistant Lecturer of Cardiology Mansoura University AGENDA SPECIAL GROUPS SPECIFIC DRUDS FOR SPECIAL GROUPS TARGET BP FOR SPECIAL GROUPS:
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 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 information1. Albuminuria an early sign of glomerular damage and renal disease. albuminuria
1. Albuminuria an early sign of glomerular damage and renal disease albuminuria Cardio-renal continuum REGRESS Target organ damage Asymptomatic CKD New risk factors Atherosclerosis Target organ damage
More informationAdolescent renal and cardiovascular disease protection in type 1 diabetes AdDIT Study
Keystone, Colorado, July 2013 Practical Ways to Achieve Targets in Diabetes Care Adolescent renal and cardiovascular disease protection in type 1 diabetes AdDIT Study Professor David Dunger Department
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 informationFive chapters 1. What is CVD prevention 2. Why is CVD prevention needed 3. Who needs CVD prevention 4. How is CVD prevention applied 5. Where should CVD prevention be offered Shorter, more adapted to clinical
More informationYounger 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.
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 informationOBESITY IN PRIMARY CARE
OBESITY IN PRIMARY CARE Obesity- definition Is a chronic disease In ICD 10 E66 Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. Obesity is a leading
More informationCardiometabolic Side Effects of Risperidone in Children with Autism
Cardiometabolic Side Effects of Risperidone in Children with Autism Susan J. Boorin, MSN, PMHNP-BC PhD Candidate Yale School of Nursing 1 This speaker has no conflicts of interest to disclose. 2 Boorin
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 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 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 informationImplications of The LookAHEAD Trial: Is Weight Loss Beneficial for Patients with Diabetes?
Implications of The LookAHEAD Trial: Is Weight Loss Beneficial for Patients with Diabetes? Boston, MA November 7, 213 Edward S. Horton, MD Professor of Medicine Harvard Medical School Senior Investigator
More informationPage 1. Disclosures. Background. No disclosures
Population-Based Lipid Screening in the Era of a Childhood Obesity Epidemic: The Importance of Non-HDL Cholesterol Assessment Brian W. McCrindle, Cedric Manlhiot, Don Gibson, Nita Chahal, Helen Wong, Karen
More informationCenter for healthy weight and Nutrition. Primary Care Pocket Guide to. Pediatric Obesity Management
Center for healthy weight and Nutrition Primary Care Pocket Guide to Pediatric Obesity Management Introduction The Primary Care Pocket Guide to Pediatric Obesity Management is intended to provide primary
More informationIdentification of patients with heart failure and PREserved systolic Function : an Epidemiologic Regional study
Identification of patients with heart failure and PREserved systolic Function : an Epidemiologic Regional study Dr. Antonio Magaña M.D. (on behalf I-PREFER investigators group) Stockholm, Sweden, August
More informationHYPERTENSION: ARE WE GOING TOO LOW?
HYPERTENSION: ARE WE GOING TOO LOW? George L. Bakris, M.D.,F.A.S.N.,F.A.S.H., F.A.H.A. Professor of Medicine Director, ASH Comprehensive Hypertension Center University of Chicago Medicine Chicago, IL USA
More informationThe Diabetes Link to Heart Disease
The Diabetes Link to Heart Disease Anthony Abe DeSantis, MD September 18, 2015 University of WA Division of Metabolism, Endocrinology and Nutrition Oswald Toosweet Case #1 68 yo M with T2DM Diagnosed DM
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 information2003 World Health Organization (WHO) / International Society of Hypertension (ISH) Statement on Management of Hypertension.
2003 World Health Organization (WHO) / International Society of Hypertension (ISH) Statement on Management of Hypertension Writing Group: Background Hypertension worldwide causes 7.1 million premature
More informationEvaluation and Treatment of Childhood Obesity
Evaluation and Treatment of Childhood Obesity Stephen R. Daniels, MD, PhD Department of Pediatrics University of Colorado School of Medicine and Children s Hospital Colorado In 1953, Morris et al compared
More informationOptimizing Postpartum Maternal Health to Prevent Chronic Diseases
Optimizing Postpartum Maternal Health to Prevent Chronic Diseases Amy Loden, MD, FACP, NCMP Disclosures Research: None Financial: none applicable to this presentation PRIUM QEssentials Market Research
More informationUpdate on Current Trends in Hypertension Management
Friday General Session Update on Current Trends in Hypertension Management Shawna Nesbitt, MD Associate Dean, Minority Student Affairs Associate Professor, Department of Internal Medicine Office of Student
More informationUniversity of Padova, Padua, Italy, and HARVEST Study Group, Italy
University of Padova, Padua, Italy, and HARVEST Study Group, Italy ISOLATED SYSTOLIC HYPERTENSION IN THE YOUNG DOES NOT IMPLY AN INCREASED RISK OF FUTURE HYPERTENSION NEEDING TREATMENT Mos L, Saladini
More informationFrom the desk of the: THE VIRTUAL NEPHROLOGIST
Hypertension, also referred to as high blood pressure or HTN, is a medical condition in which the blood pressure is chronically elevated. It is a very common illness. One out of three American adults has
More informationChronic Pediatric Hypertension
Chronic Pediatric Hypertension Nephrology Grand Round 3/13/2015 Mahmoud Kallash M.D Outline Definition of hypertension (HTN) Challenges in diagnosing HTN Epidemiology Causes and evaluation of HTN Management
More informationHSN301 REVISION NOTES TOPIC 1 METABOLIC SYNDROME
HSN301 REVISION NOTES TOPIC 1 METABOLIC SYNDROME What does the term Metabolic Syndrome describe? Metabolic syndrome describes a cluster of cardio-metabolic conditions that increase one's risk of developing
More informationEffective Date: TBD Version: 1.0 (Revised: 6/11/2014)
Protocol Title: Hypertension Effective Date: TBD Version: 1.0 (Revised: 6/11/2014) Approval By: TBD Planned Review Date: TBD 1 Purpose & Objective This protocol provides evidence-based care recommendations
More informationCardiovascular Diseases in CKD
1 Cardiovascular Diseases in CKD Hung-Chun Chen, MD, PhD. Kaohsiung Medical University Taiwan Society of Nephrology 1 2 High Prevalence of CVD in CKD & ESRD Foley RN et al, AJKD 1998; 32(suppl 3):S112-9
More informationNew Hypertension Guideline Recommendations for Adults July 7, :45-9:30am
Advances in Cardiovascular Disease 30 th Annual Convention and Reunion UERM-CMAA, Inc. Annual Convention and Scientific Meeting July 5-8, 2018 New Hypertension Guideline Recommendations for Adults July
More informationLessons learned from AASK (African-American Study of Kidney Disease and Hypertension)
Lessons learned from AASK (African-American Study of Kidney Disease and Hypertension) Janice P. Lea, MD, MSc, FASN Professor of Medicine Chief Medical Director of Emory Dialysis ASH Clinical Specialist
More informationOverview. 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
More informationManagement of High Blood Pressure in Children and Adolescents
Π.Μ.Σ. «ΜΟΝΑΔΕΣ ΕΝΤΑΤΙΚΗΣ ΘΕΡΑΠΕΙΑΣ - ΚΑΡΔΙΟΛΟΓΙΚΗ ΝΟΣΗΛΕΥΤΙΚΗ» Management of High Blood Pressure in Children and Adolescents ΕΠΙΔΡΑΣΗ ΤΗΣ ΑΝΤΙΥΠΕΡΤΑΣΙΚΗΣ ΑΓΩΓΗΣ ΣΤΗΝ ΑΡΤΗΡΙΑΚΗ ΣΚΛΗΡΙΑ ΥΠΕΡΤΑΣΙΚΩΝ ΑΣΘΕΝΩΝ
More informationHypertension CHAPTER-I CARDIOVASCULAR SYSTEM. Dr. K T NAIK Pharm.D Associate Professor Department of Pharm.D Krishna Teja Pharmacy College, Tirupati
CHAPTER-I CARDIOVASCULAR SYSTEM Hypertension SUB: PHARMACOTHERAPEUTICS-I CODE:T0820006 Dr. K T NAIK Pharm.D Associate Professor Department of Pharm.D Krishna Teja Pharmacy College, Tirupati Hypertension
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 informationTo reduce the risk of cardiovascular disease and diabetes among Oklahoma state employees.
E Nancy A. Haller, MPH, CHES, Manager, State Wellness Program M PLOYEES To reduce the risk of cardiovascular disease and diabetes among Oklahoma state employees. To suspend or decrease the rising costs
More informationGDF-15 levels but not NTproBNP levels predict diastolic heart failure in morbid obesity
GDF-15 levels but not NTproBNP levels predict diastolic heart failure in morbid obesity M. Fischer, C. Strack, J. Bruxmeier, F. Wagner, E. Rousseva, G. Schmitz, G. Riegger, A. Baessler Clinic for Internal
More informationHypertension Update Background
Hypertension Update Background Overview Aaron J. Friedberg, MD Assistant Professor, Clinical Division of General Internal Medicine The Ohio State University Wexner Medical Center Management Guideline Comparison
More informationStudy of Serum Hepcidin as a Potential Mediator of the Disrupted Iron Metabolism in Obese Adolescents
Study of Serum Hepcidin as a Potential Mediator of the Disrupted Iron Metabolism in Obese Adolescents Prof. Azza Abdel Shaheed Prof. of Child Health NRC National Research Centre Egypt Prevalence of childhood
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 informationJOSHUA K. KAYIMA INTERLINKING CARDIOVASCULAR DISEASE, CHRONIC KIDNEY DISEASE, AND OBESITY
INTERLINKING CARDIOVASCULAR DISEASE, CHRONIC KIDNEY DISEASE, AND OBESITY JOSHUA K. KAYIMA ASSOCIATE PROFESSOR DEPT. OF CLINICAL MEDICINE AND THERAPEUTICS UNIVERSITY OF NAIROBI Introduction According to
More informationUsing the New Hypertension Guidelines
Using the New Hypertension Guidelines Kamal Henderson, MD Department of Cardiology, Preventive Medicine, University of North Carolina School of Medicine Kotchen TA. Historical trends and milestones in
More informationLONG-TERM EFFECTS OF SURGICAL MENAGEMENT OF PRIMARY ALDOSTERONISM ON THE CARDIOVASCULAR SISTEM
LONG-TERM EFFECTS OF SURGICAL MENAGEMENT OF PRIMARY ALDOSTERONISM ON THE CARDIOVASCULAR SISTEM Riccardo Marsili, Pietro Iacconi, Massimo Chiarugi, Giampaolo Bernini*, Alessandra Bacca*, Paolo Miccoli Department
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 informationHypertension and Hyperlipidemia. University of Illinois at Chicago College of Nursing
Hypertension and Hyperlipidemia University of Illinois at Chicago College of Nursing 1 Learning Objectives 1. Provide a basic level of knowledge regarding hypertension and hyperlipidemia and care coordinators/
More information«Πατσζαρκία και Καρδιαγγειακή Νόζος»
«Πατσζαρκία και Καρδιαγγειακή Νόζος» Δημήτρης Π. Παπαδόπουλος-FESC Clinical Assist. Professor George Washington University USA Επιμελητής Καρδιολογικής Κλινικής Π.Γ.Ν.Α. «ΛΑΪΚΟ» Υπεύθυνος Αντιυπερτασικού
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 informationInclusion Criteria: 3 years of age and have had at least 2 visits in the last year Exclusion Criteria: BMI 85 th percentile
Inclusion Criteria: 3 years of age and have had at least 2 visits in the last year Exclusion Criteria: BMI 85 th percentile Document the Measurement of Blood Pressure (BP) 90% of patients diagnosed with
More informationMesures non médicamenteuses pour prévenir et traiter une hypertension artérielle. JM Krzesinski Service de Néphrologie- Hypertension ULg-CHU Liège
Mesures non médicamenteuses pour prévenir et traiter une hypertension artérielle JM Krzesinski Service de Néphrologie- Hypertension ULg-CHU Liège Disclosure No competing interest to declare about this
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 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 informationHypertension Update. Aaron J. Friedberg, MD
Hypertension Update Aaron J. Friedberg, MD Assistant Professor, Clinical Division of General Internal Medicine The Ohio State University Wexner Medical Center Background Diagnosis Management Overview Guideline
More informationEstablished Risk Factors for Coronary Heart Disease (CHD)
Getting Patients to Make Small Lifestyle Changes That Result in SIGNIFICANT Improvements in Health - Prevention of Diabetes and Obesity for Better Health Maureen E. Mays, MD, MS, FACC Director ~ Portland
More informationWessex Paediatric Oncology Supportive Care Guidelines: Management of Hypertension.
Wessex Paediatric Oncology Supportive Care Guidelines: Management of Hypertension. Scope This guideline applies to all paediatric oncology patients in the region. It does not apply to neonates on neonatal
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 informationBlood Pressure Acre Surgery Diviash Thakrar
Blood Pressure Acre Surgery Diviash Thakrar Why Are We Doing This? 1. Improve education for patients within the practice 2. Allow us use this for general health promotion Raise money for charity 3. Raise
More informationConflict of Interest Disclosure Obesity Treatment: What Is a Staged Approach & What Does it Mean for Clinicians?
Conflict of Interest Disclosure Obesity Treatment: What Is a Staged Approach & What Does it Mean for Clinicians? Nothing to declare Nancy F. Krebs, MD, MS University of Colorado Denver School of Medicine
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 information