JNC 8 -Controversies. Sagren Naidoo Nephrologist CMJAH
|
|
- Elisabeth Stevens
- 5 years ago
- Views:
Transcription
1 JNC 8 -Controversies Sagren Naidoo Nephrologist CMJAH
2 Joint National Committee (JNC) Panel appointed by the National Heart, Lung, and Blood Institute (NHLBI) First guidelines (JNC-1) published in 1977 Subsequent updates published in 3- to 6-year intervals Last edition (JNC-7) published in 2003 Chobanian AV et al. JAMA 2003;289:
3 Guidelines The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) Updated 2003 Succinct evidence-based recommendations. Published in JAMA May 21, 2003,
4 JNC-7 Blood Pressure Classification Blood Pressure Classification Systolic blood pressure (mm Hg) Diastolic blood pressure (mm Hg) Normal < 120 < 80 Pre-hypertension Stage 1 hypertension Stage 2 hypertension > 160 > 100 Chobanian AV et al. JAMA 2003;289:
5 JNC-7 Treatment Algorithm
6 JNC-7 Compelling Indications Chobanian AV et al. JAMA 2003;289:
7 Development of JNC-8 Commissioned by the NHLBI in 2008 Panel members appointed Developed focused critical questions relevant to practiceconducted a systematic search of pertinent literature Limited to randomized controlled trials (RCTs) published between 1966 and 2009 Included patients age 18 or older with hypertension Sample size of 100 patients or more Results must have included hard outcomes Subsequent search of studies from 2009 to 2013 required samples of 2000 or more patients James PA et al. JAMA 2014;311:
8 Development of JNC-8 3 critical questions for adults with hypertension: Does initiating antihypertensive pharmacologic therapy at specific blood pressure thresholds improve health outcomes? [When to start therapy?] Does treatment with antihypertensive pharmacologic therapy to a specified blood pressure goal lead to improvements in health outcomes? [How low should I go?] Do various antihypertensive drugs or drug classes differ in comparative benefits and harms on specific health outcomes? [What drug do I use?] James PA et al. JAMA 2014;311:507-20
9 Development of JNC-8 And then we wait and wait
10 JAMA published the long-awaited Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure-8 (JNC- 8) guidelines December 18, 2013.
11 JNC 8: Hypertension Management Evidence Review Limited to RCT s: Hypertensive adults > 18 years old Sample size > 100 Follow-up > 1 year Reported effect of treatment on important health outcomes (mortality, MI, HF, CVA, ESRD) January 1966 to December 2009 Separate criteria used of RCT s published after December 2009 Omitted observational, epidemiological and non randomised data
12
13 JNC 8: Graded Recommendations A Strong evidence B Moderate evidence C Weak evidence D Against E Expert Opinion N No recommendation
14 JNC 8: Hypertension Management Evidence Review RCT s December 2009 August Major study in hypertension ACCORD, NEJM > 2,000 participants 3. Multicentered 4. Met all other inclusion/exclusion criteria
15 JNC 8: Graded Recommendations JNC-8 report matter-of-factly acknowledged 2 limitations-not a systemmatic review and not a thorough analysis of the dat Did not include observational studies, systematic reviews, or meta-analyses, panel did not conduct its own meta-analysis based on prespecified inclusion criteria. Thus, information from these types of studies was not incorporated into the evidence statements or recommendations. Although adverse effects and harms of antihypertensive treatment documented in the RCTs were considered when the panel made its decisions,, the review was not designed to determine whether therapy-associated adverse effects and harms resulted in significant changes in important health outcomes
16 But Wait There s More The last 3 RCTs (Jatos, Ogihara, and Verdecchia) involved almost exclusively stage 2 hypertension patients and had no placebo control arms. These studies tell us nothing about the efficacy and safety of drugs for mild hypertension. The JNC-8 authors referenced 5 RCTs as providing high quality evidence to support their strong (Grade A) recommendation for drug use above a threshold of DBP 90:
17 Trials that combined stage 1 and 2 Hypertension patients. The hypertension detection and follow up program (HDFP) The U.K. Medical Research Council Working Party trial (DBP ) The Hypertension-Stroke Cooperative Study Group study found no benefit from blood pressure lowering drugs in patients after a stroke The Australian therapeutic trial in mild hypertension combined stage 1 and stage 2 hypertension patients. The Effects morbidity of treatment on hypertension study mixed stage 1 and 2 patients.
18 But Wait There s More TheCochrane Database of Systematic Reviews found no evidence supporting drug treatment for patients of any age with mild hypertension (SBP: and/or DBP 90-99) and no previous cardiovascular disease, diabetes, or renal disease (i.e., low risk). The JNC-8 hypertension guidelines are not endorsed by the National Heart, Lung, and Blood Institute (NHLBI), the American Heart Association, the American College of Cardiology, nor any other authoritative body.
19 But Wait There s More A multitude of other hypertension guidelines were also published in 2013: AHA/ACC/CDC advisory algorithm American Society of Hypertension/International Society of Hypertension (ASH/ISH) European Society of Hypertension and European Society of Cardiology (ESH/ESC) Canadian Hypertension Education Program (CHEP) J Hypertnsion 2013;31: Hypertension online November 15, J Hypertension 2014;32:3-15
20 JNC-8 Recommendations In patients >60 years of age, start medications at blood pressure of >150/90mm Hg and treat to goal of <150/90mm Hg In patients >60 years of age, treatment does not need to be adjusted if achieved blood pressure is lower than goal and well-tolerated James PA et al. JAMA 2014;311:
21 Hypertension in the Elderly
22 Hypertension in the Elderly Fastest growing segment of the population Prevalence of hypertension is very high Several issues make managing HTN unique: Often present with isolated systolic HTN More likely to present with comorbidities Many clinical trials in HTN have excluded these patients (particularly for those 80 years and older) Elderly are more susceptible to certain adverse effects (orthostatic hypotension
23 Hypertension in the Elderly They recommended blood pressure lowering drug treatment for patients 60-years-old with systolic blood pressure (SBP) 150 or diastolic blood pressure (DBP) 90 mm Hg. For patients < 60-years-old, they recommended medications for DBP 90 mm Hg. They classified both of these recommendations as Grade A (strong). To say the least, the evidence-basis for the drug treatment recommendations for mild hypertension in this report is in dispute.
24 Hypertension in the Elderly In relation to this changed drug treatment threshold recommendation, the JNC-8 panel cited 6 RCTs. The first 3 of these placebo controlled RCTs (Staessen,Beckett, and SHEP) involve only patients with stage 2 hypertension (SBP 160) rather than mild (stage 1) hypertension. RCTs of stage 2 patients say nothing about the important issue, which is whether the threshold to begin drug treatment should be at SBP = 140, 150, or 160. The widely acknowledged benefits of drugs for stage 2 hypertension were inappropriately extrapolated to apply to patients with stage 1 hypertension.
25 HYVET HYpertension in the Very Elderly Trial: Randomized, double-blind trial Included patients aged 80 or older with SBP>160mmHg Randomized to indapamide +/- perindopril or placebo Target BP of 150/80mmHg Primary outcome of fatal or nonfatal stroke Beckett NS et al. N Engl J Med 2008;358:
26 HYVET Results Mean BP at the end of the trial Indapamide +/- perindopril - 143/78 mm Hg Placebo 158/84 mm Hg 48.0% of indapamide patients achieved goal BP vs. 19.9% of placebo patients (p<0.001) Outcomes with indapamide +/- perindopril 30% reduction in stroke (p=0.06) 64% reduction in heart failure (p<0.001) 21% reduction in all-cause mortality (p=0.02) Beckett NS et al. N Engl J Med 2008;358:
27 Hypertension in the Elderly HYVET demonstrated that treatment of HTN to goal BP less than 150/80 mm Hg in patients >80 years old was safe and effective But what about a lower BP goal? And what about the patients age 60-80?
28 the International Verapamil- Trandolapril Study (INVEST) Analysis showing that patients over age 60 in who achieved an SBP target of >150 mm Hg had more deaths and cardiovascular events than those whose systolic blood pressure was reduced to below 140 mm Hg Among the more than 8350 patients included in the analysis, patients who achieved SBPs lower than 140 mm Hg over two years of follow-up had the lowest rates of the primary outcome (first occurrence of all-cause death, CV mortality, total MI, nonfatal MI, total stroke, nonfatal stroke, heart failure, or revascularization).
29 Hypertension in the Elderly Two treat-to-target trials in this age group: Japanese Trial to Assess Optimal SBP (JATOS) 4416 patients aged (average age of 74) Randomized to SBP<140 vs. SBP Achieved BP of 136/75 vs. 146/78 No difference in CV events or renal failure (p=0.99) VALISH trial 3079 patients aged (average age of 76) Randomized to SBP<140 or SBP No significant reductions in stroke, CV events, or renal failure Overall event rates were lower than anticipated in both of these studies JATOS Study Group. Hypertens Res 2008;31: Ogihara T et al. Hypertension 2010;56:
30 Hypertension in the Elderly Dissension among the ranks! Ann Intern Med. January 14, /17 authors (29%) Insufficient evidence to increase target SBP to 150 mmhg. Expertise vs. Scientific Evidence Wright JT Jr et al. Ann Intern Med 2014;160:
31 Hypertension in the Elderly The opposing arguments: The Japanese trials had low event rates and may not represent the risks in other populations Data from other studies suggests a goal SBP closer to 140mm Hg may be more appropriate for ages Methodology may have prevented JNC-8 panel from considering the results in their analysis The Speed Limit effect Wright JT Jr et al. Ann Intern Med 2014;160:
32 JNC-8 Recommendations In patients <60 years of age, start medications at blood pressure of >140/90mm Hg and treat to goal of <140/90mm Hg In all adult patients with diabetes or chronic kidney disease, start medications at blood pressure of >140/90mm Hg and treat to goal of <140/90mm Hg James PA et al. JAMA 2014;311:
33 JNC-8 Recommendations Controversy They classified both of these recommendations as Grade A (strong). To say the least, the evidence-basis for the drug treatment recommendations for mild hypertension in this report is in dispute.
34 Hypertension in Diabetics Action to Control CV Risk in Diabetes (ACCORD) Randomized, double-blind trial Included patients with T2DM and high CV risk Randomized to SBP<120 or SBP<140 Primary outcome of CV death, MI, or stroke Results: Mean SBP of 119 mm Hg vs. 133 mm Hg No significant difference in primary outcome (HR=0.88, p=0.2) Incidence of stroke was lower with intensive treatment (HR 0.59, p=0.01) Significant increase in serious adverse events
35 JNC-8 Recommendations For the non-black population (including diabetes), initial antihypertensive treatment may include a thiazide, ACEI, ARB, or CCB For the black population (including diabetes), initial antihypertensive treatment should include a thiazide or CCB For all patients with CKD, initial (or add-on) therapy for hypertension should include an ACEI or ARB James PA et al. JAMA 2014;311:
36 Initial Drug Selection for HTN ALLHAT: Randomized, double-blind trial Enrolled 33,357 patients age 55 or older Chlorthalidone Amlodipine Lisinopril Doxazosin (this arm stopped early 2 worse outcomes) Primary outcome of CHD death or nonfatal MI No significant difference in primary outcome among the thiazide, ACEI, or CCB The ALLHAT Collaborative Research Group. JAMA 2002;288:
37 Initial Drug Selection for HTN African-American patients: High risk for CV events Less responsive to drugs that act on the renin-angiotensinaldosterone system ACEI, ARB, BB Subgroup analysis of black patients in ALLHAT Less BP reduction with lisinopril than amlodipine Risk of stroke was significantly higher with lisinopril than with amlopdipine (RR 1.51, 95% CI ) Lisinopril less effective than chlorthalidone in preventing heart failure, stroke, and combined CHD The ALLHAT Collaborative Research Group. JAMA 2002;288:
38 Initial Drug Selection for HTN What happened to the beta-blockers (BB)? Most evidence for BB is from atenolol Does not meet current FDA criteria for a once-daily drug Losartan Intervention for Endpoint reduction (LIFE) study Compared losartan vs. atenolol in pts. with HTN & LVH Primary outcome of CV death, MI, or stroke Overall 13% RRR with losartan vs. atenolol (p=0.021) Driven mainly by 25% reduction in risk of stroke (p=0.001) BB still recommended for many patients with comorbid conditions (CHF, CAD, etc.) Dahloff B et al. Lancet 2002;359:
39 Comparisons to Other Guidelines BP Goal JNC-7 JNC-8 ASH/ISH ESC/ES H CHEP Age < 60 <140/90 <140/90 <140/90 <140/90 <140/90 Age <140/90 <150/90 <140/90 <140/90 <140/90 Age 80+ <140/90 <150/90 <150/90 <150/90 <150/90 Diabetes <130/80 <140/90 <140/90 <140/85 <130/80 CKD <130/80 <140/90 <140/90 <130/90 <140/90 Adapted from Salvo M et al. Ann Pharmacother 2014;48:1242-8
40 Comparisons to Other Guidelines JNC-7 JNC-8 ASH/ISH ESC/ESH CHEP Non-black (no DM or CKD) Thiazide Thiazide, ACEI, ARB, CCB <60:ACEI,A RB >60:CCB, thiazide Thiazide, ACEI, ARB, CCB, BB Thiazide, ACEI, ARB (BB if <60) Black (no DM or CKD) Thiazide Thiazide, CCB Thiazide, CCB Thiazide, ACEI, ARB, CCB, B Thiazide, ARB (BB if <60) Diabetes ACEI, ARB, CCB, BB, thiazide CCB, thiazide ACEI, ARB, CCB, thiazide ACEI, ARB ACEI, ARB, CCB, thiazide CKD ACEI, ARB ACEI, ARB ACEI, ARB ACEI, ARB ACEI, ARB Adapted from Salvo M et al. Ann Pharmacother 2014;48:1242-8
41 2013 ESH/ESC Guidelines for the management of arterial hypertension Blood pressure goals in hypertensive patients Recommendations SBP goal for most Patients at low moderate CV risk Patients with diabetes Consider with previous stroke or TIA Consider with CHD Consider with diabetic or non-diabetic CKD SBP goal for elderly Ages <80 years Initial SBP 160 mmhg SBP goal for fit elderly Aged <80 years SBP goal for elderly >80 years with SBP 160 mmhg DBP goal for most DB goal for patients with diabetes <140 mmhg mmhg <140 mmhg mmhg <90 mmhg <85 mmhg SBP, systolic blood pressure; CV, cardiovascular; TIA, transient ischaemic attack; CHD, coronary heart disease; CKD, chronic kidney disease; DBP, diastolic blood pressure. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31: Medical Education & Information for all Media, all Disciplines, from all over the World Powered by
42 What is the goal BP?
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
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 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 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 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 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 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 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 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 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 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 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 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 informationConflicts of Interest. Hypertension Guidelines Have Your Blood Pressure Up? Learning Objectives-Technician. Learning Objectives-Pharmacist
Conflicts of Interest Hypertension Guidelines Have Your Blood Pressure Up? Diana Isaacs, PharmD, BCPS, BC-ADM, has no actual or potential conflicts of interest in relation to this program. Diana Isaacs,
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 informationNew Lipid Guidelines. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids.
PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Disclosure No relevant
More 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 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 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 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. 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 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 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 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 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 information2014 HYPERTENSION GUIDELINES
2014 HYPERTENSION GUIDELINES Eileen M. Twomey, Pharm.D., BCPS 1 Learning Objectives Describe specific blood pressure thresholds at which antihypertensive therapy should be initiated and blood pressure
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 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 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 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 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 informationUpdate in Cardiology Pharmacologic Management of Cardiovascular Risk. Christopher C. Roe, MSN, ACNP
Update in Cardiology Pharmacologic Management of Cardiovascular Risk Christopher C. Roe, MSN, ACNP Objectives 1. Verbalize understanding of new pharmacologic guidelines in the treatment of hypertension
More 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 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 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 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 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 informationBlood pressure treatment target in diabetes. Should it be <130 mmhg?
Blood pressure treatment target in diabetes Should it be
More informationConflicts of Interest. Hypertension Guidelines Have Your Blood Pressure Up? Learning Objectives-Technician. Learning Objectives-Pharmacist
Conflicts of Interest Hypertension Guidelines Have Your Blood Pressure Up? Diana Isaacs, PharmD, BCPS, BC-ADM, has no actual or potential conflicts of interest in relation to this program. Diana Isaacs,
More informationHypertension 2015: Recent Evidence that Will Change Your Practice
Hypertension 2015: Recent Evidence that Will Change Your Practice Gerald W. Smetana, M.D. Division of General Medicine Beth Israel Deaconess Medical Center Professor of Medicine Harvard Medical School
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 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 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 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 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 informationALLHAT Role of Diuretics in the Prevention of Heart Failure - The Antihypertensive and Lipid- Lowering Treatment to Prevent Heart Attack Trial
1 ALLHAT Role of Diuretics in the Prevention of Heart Failure - The Antihypertensive and Lipid- Lowering Treatment to Prevent Heart Attack Trial Davis BR, Piller LB, Cutler JA, et al. Circulation 2006.113:2201-2210.
More 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 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 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 informationDisclosures. Hypertension: Nationwide Dilemma. Learning Objectives. What s Currently Recommended? Specific Concerns 3/9/2012
How Should We ACCOMPLISH Good Blood Pressure Control In Our VETS? Disclosures No conflicts of interest to disclose Updates in the Management of HypertensionIn the Elderly Antoine T. Jenkins, Pharm.D.,
More informationWhich antihypertensives are more effective in reducing diastolic hypertension versus systolic hypertension? May 24, 2017
Which antihypertensives are more effective in reducing diastolic hypertension versus systolic hypertension? May 24, 2017 The most important reason for treating hypertension in primary care is to prevent
More informationRecent Hypertension Guidelines
Recent Hypertension Guidelines Lawrence J. Fine, MD, DrPH, FAHA Division of Cardiovascular Sciences NHLBI/NIH February 19, 2014 Disclosures: Member of Panel Appointed to the Eighth Joint National Committee
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 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 informationThe JNC 8 Guidelines: A Clinical Review
8 Osteopathic Family Physician (2015)1, 8-12 Osteopathic Family Physician, Volume 7, No. 1, January/February 2015 The JNC 8 Guidelines: A Clinical Review Gary Rivard, DO; Erik Seth Kramer, DO, MPH; Sean
More informationImplementation of JNC- 8 Hypertension Recommendations: Combining evidence and value-based practice strategies for accountable care
Implementation of JNC- 8 Hypertension Recommendations: Combining evidence and value-based practice strategies for accountable care Shari Bolen MD, MPH MetroHealth/Case Western Reserve University 1 Disclosure
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 informationRandomized 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
More informationJNC-8. (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure- 8) An Update on Hypertension Guidelines
JNC-8 (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure- 8) An Update on Hypertension Guidelines Derrick Sorweide, DO Assistant Professor of Family Medicine,
More informationManaging Hypertension in 2018
MANAGING HYPERTENSION IN 2018 How Do We Work With Conflicting Data and Conflicting Guidelines? Disclosure No relevant financial relationships Robert B. Baron, MD MS Professor and Associate Dean UCSF School
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 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 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 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 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 informationBlood Pressure LIMBO How Low To Go?
Blood Pressure LIMBO How Low To Go? Joseph L. Kummer, MD, FACC Bryan Heart Spring Conference April 21 st, 2018 Hypertension Epidemiology Over a billion people have hypertension Major cause of morbidity
More informationNew Hypertension Guidelines: Why the change? Neil Brummond, M.D. Avera Medical Group Internal Medicine Sioux Falls, SD
New Hypertension Guidelines: Why the change? Neil Brummond, M.D. Avera Medical Group Internal Medicine Sioux Falls, SD None Disclosures Objectives Understand trend in blood pressure clinical practice guidelines
More informationADVANCES IN MANAGEMENT OF HYPERTENSION
Prevalence 29%; Blacks 33.5% About 72.5% treated; 53.5% uncontrolled (>140/90) Risk for poor control: Latinos, Blacks, age 18-44 and 80,
More informationManagement of High Blood Pressure in Adults
Management of High Blood Pressure in Adults Based on the Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC8) James, P. A. (2014, February 05). 2014 Guideline for Management
More informationNew Clinical Trends in Geriatric Medicine. April 8, 2016 Amanda Lathia, MD, MPhil Staff, Center for Geriatric Medicine
New Clinical Trends in Geriatric Medicine April 8, 2016 Amanda Lathia, MD, MPhil Staff, Center for Geriatric Medicine Objectives Review current guidelines for blood pressure (BP) control in older adults
More informationHypertension in the Elderly. John Puxty Division of Geriatrics Center for Studies in Aging and Health, Providence Care
Hypertension in the Elderly John Puxty Division of Geriatrics Center for Studies in Aging and Health, Providence Care Learning Objectives Review evidence for treatment of hypertension in elderly Consider
More informationRenal Denervation. by Walead Latif, DO, MBA, CPE Assistant Clinical Professor Rutgers Medical School
Renal Denervation by Walead Latif, DO, MBA, CPE Assistant Clinical Professor Rutgers Medical School Disclosure Information ACOI Annual Meeting I have the following financial relationships to disclose:
More informationBLOOD PRESSURE-LOWERING TREATMENT
BLOOD PRESSURE-LOWERING TRIALS NUMBER OF PARTICIPANTS NUMBER OF PERCENTAGE OF MEAN AGE MEAN - (YEARS) TRIALS WITH ANALYSIS BY GENDER N, (%) 69,473 28,008 40.3% 70.2 3.2 3/5 (60%) APPENDIX 2 1 BLOOD PRESSURE-LOWERING
More informationConflict of Interest Disclosure
HYPERTENSION UPDATE: NEW JNC 8 Guideline vs OLD Federal Motor Carrier Safety Regulations PLEASE STAND BY WEBINAR WILL BEGIN AT 12:00 PM PST FOR AUDIO: CALL 866-740-1260 / ACCESS CODE: 764-4915# Conflict
More informationLong-Term Care Updates
Long-Term Care Updates August 2015 By Darren Hein, PharmD Hypertension is a clinical condition in which the force of blood pushing on the arteries is higher than normal. This increases the risk for heart
More informationDiversity 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
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. 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 IN THE ELDERLY A BALANCED APPROACH. Barry Goldlist October 31, 2014
HYPERTENSION IN THE ELDERLY A BALANCED APPROACH Barry Goldlist October 31, 2014 DISCLOSURE I have not accepted any money for myself from any pharmaceutical company in the 21 st century I have accepted
More informationIndividual management of arterial hypertension. Doumas Michael, Internist Lecturer, Aristotle University, Thessaloniki
Individual management of arterial hypertension Doumas Michael, Internist Lecturer, Aristotle University, Thessaloniki From Population to Individual Management of Arterial Hypertension Epidemiologic impact
More informationHighlights of the new blood pressure and cholesterol guidelines: A whole new philosophy. Jeremy L. Johnson, PharmD, BCACP, CDE, BC-ADM
Highlights of the new blood pressure and cholesterol guidelines: A whole new philosophy Jeremy L. Johnson, PharmD, BCACP, CDE, BC-ADM OSHP 2014 Annual Meeting Oklahoma City, OK April 4, 2014 1 Objectives
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 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 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 informationMasked Hypertension. Why Should We Care? Dr. Peter J. Lin Director Primary Care Initiatives - Canadian Heart Research Centre
Masked Hypertension Why Should We Care? Dr. Peter J. Lin Director Primary Care Initiatives - Canadian Heart Research Centre PRESENTER DISCLOSURE Faculty: Dr. Peter Lin Relationships with commercial interests:
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 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 informationChapman University Digital Commons. Chapman University. Michael S. Kelly Chapman University,
Chapman University Chapman University Digital Commons Pharmacy Faculty Articles and Research School of Pharmacy 12-30-2016 Assessment of Achieved Systolic Blood Pressure in Newly Treated Hypertensive Patients
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: 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 informationManaging HTN in the Elderly: How Low to Go
Managing HTN in the Elderly: How Low to Go Laxmi S. Mehta, MD, FACC The Ohio State University Medical Center Assistant Professor of Clinical Internal Medicine Clinical Director of the Women s Cardiovascular
More 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 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 informationAbbreviations Cardiology I
Cardiology I and Clinical Controversies Joseph J. Saseen, Pharm.D., FCCP, BCPS (AQ Cardiology) Reviewed by Stuart T. Haines, Pharm.D., FCCP, BCPS; and Michelle M. Richardson, Pharm.D., FCCP, BCPS Learning
More informationIs there a mechanism of interaction between hypertension and dyslipidaemia?
Is there a mechanism of interaction between hypertension and dyslipidaemia? Neil R Poulter International Centre for Circulatory Health NHLI, Imperial College London Daegu, Korea April 2005 Observational
More informationHypertension Guidelines: Lessons for Primary Care. Paul A James MD Professor and Chair Department of Family Medicine University of Washington
Hypertension Guidelines: Lessons for Primary Care Paul A James MD Professor and Chair Department of Family Medicine University of Washington Disclaimer and Financial Disclosure I have no financial interests
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 informationALLHAT. ALLHAT Antihypertensive Trial Results by Baseline Diabetic & Fasting Glucose Status
ALLHAT Antihypertensive Trial Results by Baseline Diabetic & Fasting Glucose Status 1 Introduction and Background Clinical trials have reported reduction in CV events with diuretics, CCBs, ACE inhibitors,
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 information