ALLHAT. Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic
|
|
|
- Todd French
- 5 years ago
- Views:
Transcription
1 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 vs Diuretic The Antihypertensive and Lipid-Lowering Lowering Treatment to Prevent Heart Attack Trial () The Collaborative Research Group Sponsored by the National Heart, Lung, and Blood Institute (NHLBI) National Heart, Lung, and Blood Institute JAMA 2002;288:
2 2 Antihypertensive Trial Design Randomized, double-blind, multi-center clinical trial Determine whether occurrence of fatal CHD or nonfatal MI is lower for high-risk hypertensive patients treated with newer agents (CCB, ACEI, alpha-blocker) compared with a diuretic 42,418 high-risk hypertensive patients 55 years
3 3 Background In addition to their BP lowering potential all antihypertensive agents have other important mechanisms of action and indications. These actions may convey benefits or risks independent of BP lowering By having a common BP goal for all treatment arms, aimed to evaluate the health effects of these non-bp actions
4 4 Secondary Outcomes All-cause mortality Stroke Combined CHD nonfatal MI, CHD death, coronary revascularization, hospitalized angina Combined CVD (CHD, stroke, coronary revascularizations, heart failure [treated nonhospitalized, hospitalized, fatal], angina (treated non-hospitalized, hospitalized), peripheral arterial disease (revascularization procedure)
5 5 Secondary Outcomes (Continued) HQOL (Health-related quality of life) GI Bleeding Costs
6 6 Step 1 Treatment Protocol Step 1 Agent Initial Dose* Dose 1* Dose 2* Dose 3* Chlorthalidone Amlodipine Lisinopril Doxazosin * mg/day
7 7 Step Up Treatment Protocol Step 2 Agents: Dose 1* Dose 2* Dose 3* Reserpine 0.05 qd 0.1 qd 0.2 qd or 0.1 qod Clonidine (oral) 0.1 bid 0.2 bid 0.3 bid Atenolol 25 qd 50 qd 100 qd Step 3 Agent: Hydralazine 25 bid 50 bid 100 bid *All doses in mg
8 8 Baseline Characteristics Chlorthalidone 15,255 Amlodipine 9,048 Lisinopril 9,054 Mean SBP/DBP 146 / / / 84 Treated (90%) 145 / / / 84 Untreated (10%) 156 / / / 89 Mean age, y Black, % Women, % Current smoking % History of CHD, % Type 2 diabetes, %
9 9 On Step 1 or Equivalent Treatment by Antihypertensive Treatment Group % Year 2 Years 3 Years 4 Years 5 Years Chlor Aml Lis
10 10 BP Results by Treatment Group Chlorthalidone Amlodipine Lisinopril C A L BL M Y Y Y C A L BL M Y Y Y mm Hg BP 140 mm Hg BP Years Years Compared to chlorthalidone: SBP significantly higher in the amlodipine group (~1 mm Hg) and the lisinopril group (~2 mm Hg). Compared to chlorthalidone: DBP significantly lower in the amlodipine group (~1 mm Hg).
11 11 Blood Pressure Control 1.6 = mean number of drugs DBP<90 SBP<140 BP<140/90 Percent % 86% 88% 90% 91% 68% years: Years of Follow-up 62% were on >2 2 drugs 30% were on 1 drug and controlled Cushman, et al. J Clin Hypertens 2002;4:393 4:
12 12 Biochemical Results Serum cholesterol- mg/dl Baseline 4 Years Serum cholesterol - > 240 mg/dl Baseline 3838 (26.5) 4 Years 1223 (14.4) Serum potassium mmol/l Baseline 4 Years Serum potassium <3.5mEq/L Baseline 4 Years * p<.05 compared to chlorthalidone Ann Intern Med. 1999;130: Chlorthalidone (43.8) (42.1) 4.3 (0.7) 4.1 (0.7) 493 (3.4) 707 (8.5) Amlodipine (44.1) (41.0)* 2284 (26.6) 673 (13.4) 4.3 (0.7) 4.4 (0.7)* 292 (3.4) 93 (1.9) Lisinopril (42.4) (40.6)* 2178 (25.4) 603 (12.8) 4.4 (0.7)* 4.5 (0.7)* 223 (2.6) 37 (0.8)
13 13 USE OF POTASSIUM SUPPLEMENTATION Chlorthalidone Amlodipine Lisinopril % on potassium suppl Year 1 Year 2 Year 3 Year 4 Year 5 Year 6
14 14 Biochemical Results Fasting Glucose mg/dl Chlorthalidone Amlodipine Total Baseline (58.3) (57.0) 4 Years (55.6) (52.0) Among baseline nondiabetics with baseline <126 mg/dl Baseline 93.1 (11.7) 93.0 (11.4) 4 Years (28.5) (27.7) Diabetes Incidence (follow-up fasting glucose 126 mg/dl) 4 Years 11.6% 9.8%* Lisinopril (56.1) (51.3)* 93.3 (11.8) (19.5)* 8.1%* *p<.05 compared to chlorthalidone
15 15 Renal Outcomes C A L A/C L/C ESRD (Rate/100 # events) 1.8 (0.1) (0.2) (0.2) 126 RR=1.12 p=.98 RR=1.11 p=0.38 GFR (4 Year) Mean (sd) 70.0 (19.7) 75.1 (20.7) 70.7 (20) p<.001 p=0.03 C = Chlorthalidone; A = Amlodipine; L = Lisinopril
16 16.2 Cumulative Event Rates for the Primary Outcome (Fatal CHD or Nonfatal MI) by Treatment Group RR (95% CI) p value.16 A/C 0.98 ( ) 0.65 Cumulative CHD Event Rate L/C 0.99 ( ) Chlorthalidone Amlodipine Lisinopril Years to CHD Event Number at Risk: Chlorthalidone 15,255 14,477 13,820 13,102 11,362 6,340 2, Amlodipine 9,048 8,576 8,218 7,843 6,824 3,870 1, Lisinopril 9,054 8,535 8,123 7,711 6,662 3,832 1,
17 17 Cumulative Event Rates for Stroke by Treatment Group.1 RR (95% CI) p value.08 A/C L/C 0.93 ( ) 1.15 ( ) Cumulative Stroke Rate Chlorthalidone Amlodipine Lisinopril Years to Stroke Number at risk: Chlor 15,255 14,515 13,934 13,309 11,570 6,385 3, Amlo 9,048 8,617 8,271 7,949 6,937 3,845 1, Lisin 9,054 8,543 8,172 7,784 6,765 3,891 1,
18 18 Stroke Subgroup Comparisons RR (95% CI) Total 0.93 (0.82, 1.06) Age < (0.73, 1.19) Age >= (0.81, 1.08) Men 1.00 (0.85, 1.18) Women 0.84 (0.69, 1.03) Black 0.93 (0.76, 1.14) Non-Black 0.93 (0.79, 1.10) Diabetic 0.90 (0.75, 1.08) Non-Diabetic 0.96 (0.81, 1.14) Amlodipine Better Chlorthalidone Better Total 1.15 (1.02, 1.30) Age < (0.97, 1.52) Age >= (0.98, 1.30) Men 1.10 (0.94, 1.29) Women 1.22 (1.01, 1.46) Black 1.40 (1.17, 1.68) Non-Black 1.00 (0.85, 1.17) Diabetic 1.07 (0.90, 1.28) Non-Diabetic 1.23 (1.05, 1.44) Lisinopril Better Chlorthalidone Better P =.01 for interaction
19 Cumulative Event Rates for All-Cause Mortality by Treatment Group A/C L/C RR (95% CI) 0.96 ( ) 1.00 ( ) p value Cumulative Mortality Rate Chlorthalidone Amlodipine Lisinopril Years to Death Number at risk: Chlor 15,255 14,933 14,564 14,077 12, , Amlo 9,048 8,847 8,654 8,391 7,442 4,312 2, Lisin 9,054 8,853 8,612 8,318 7,382 4,304 2,
20 20 Cumulative Event Rates for Combined CVD by Treatment Group.5 RR (95% CI) p value A/C 1.04 ( ) 0.12 Cumulative Combined CVD Event Rate L/C 1.10 ( ) Chlorthalidone Amlodipine Lisinopril < Years to Combined CVD Event Number at risk: Chlor 15,255 13,752 12,594 11,517 9,643 5,167 2, Amlo 9,048 8,118 7,451 6,837 5,724 3,049 1, Lisin 9,054 7,962 7,259 6,631 5,560 3,011 1,
21 21 Combined CVD Subgroup Comparisons RR (95% CI) Total 1.04 (0.99, 1.09) Age < (0.94, 1.12) Age >= (0.99, 1.12) Men 1.04 (0.98, 1.11) Women 1.04 (0.96, 1.13) Black 1.06 (0.96, 1.16) Non-Black 1.04 (0.97, 1.10) Diabetic 1.06 (0.98, 1.15) Non-Diabetic 1.02 (0.96, 1.09) Amlodipine Better Chlorthalidone Better Total 1.10 (1.05, 1.16) Age < (0.97, 1.15) Age >= (1.06, 1.20) Men 1.08 (1.02, 1.15) Women 1.12 (1.03, 1.21) Black 1.19 (1.09, 1.30) Non-Black 1.06 (1.00, 1.13) Diabetic 1.08 (1.00, 1.17) Non-Diabetic 1.12 (1.05, 1.19) Lisinopril Better Chlorthalidone Better P =.04 for interaction
22 22 Cumulative CHF Rate Cumulative Event Rates for Heart Failure by Treatment Group A/C L/C RR (95% CI) 1.38 ( ) 1.19 ( ) Chlorthalidone Amlodipine Lisinopril p value <.001 < Years to HF Number at risk: Chlor 15,255 14,528 13,898 13,224 11,511 6,369 3, Amlo 9,048 8,535 8,185 7,801 6,785 3,775 1, Lisin 9,054 8,496 8,096 7,689 6,698 3,789 1,
23 23 Overall Conclusions Because of the superiority of thiazide-type diuretics in preventing one or more major forms of CVD and their lower cost, they should be the drugs of choice for first-step antihypertensive drug therapy.
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
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
ALLHAT. 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,
ALLHAT 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.
Pre-ALLHAT Drug Use. Diuretics. ß-Blockers. ACE Inhibitors. CCBs. Year. % of Treated Patients on Medication. CCBs. Beta Blockers.
Pre- Drug Use % of Treated Patients on Medication 60 50 40 30 20 10 0 1978 Diuretics ß-Blockers ACE Inhibitors Year CCBs CCBs Beta Blockers Diuretics ACE Inhibitors 1980 1982 1984 1986 1988 1990 1992 IMS
ALLHAT RENAL DISEASE OUTCOMES IN HYPERTENSIVE PATIENTS STRATIFIED INTO 4 GROUPS BY BASELINE GLOMERULAR FILTRATION RATE (GFR)
1 RENAL DISEASE OUTCOMES IN HYPERTENSIVE PATIENTS STRATIFIED INTO 4 GROUPS BY BASELINE GLOMERULAR FILTRATION RATE (GFR) 6 / 5 / 1006-1 2 Introduction Hypertension is the second most common cause of end-stage
ALLHAT. U.S. Department of Health and Human Services. National Institutes of Health. National Heart, Lung, and Blood Institute
U.S. Department of Health and Human Services National Institutes of Health National Heart, Lung, and Blood Institute Review of Heart Failure Events in the Antihypertensive and Lipid Lowering Treatment
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
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
TREATMENT AND COMPLICAtions
ORIGINAL CONTRIBUTION JAMA-EXPRESS Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic The Antihypertensive and
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
Outcomes in Hypertensive Black and Nonblack Patients Treated With Chlorthalidone, Amlodipine, and Lisinopril JAMA. 2005;293:
ORIGINAL CONTRIBUTION Outcomes in Hypertensive and Patients Treated With, Amlodipine, and Lisinopril Jackson T. Wright, Jr, MD, PhD J. Kay Dunn, PhD Jeffrey A. Cutler, MD Barry R. Davis, MD, PhD William
ALLHAT Investigators Report 10-Year Follow-up and Stand by Diuretics as First-Step Antihypertensive Treatment
1 sur 5 21/11/2009 07:26 www.medscape.com Medscape Medical News from the: American Heart Association (AHA) 2009 Scientific Sessions This coverage is not sanctioned by, nor a part of, the American Heart
Hypertension. 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
Hypertension 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
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
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
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
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,
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
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
Sponsored by the National Heart, Lung, and Blood Institute (NHLBI)
1 U.S. Department of Health and Human Services The Hypertension, Detection, and Follow-up Program (HDFP) The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) National
2014 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
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
Management of Hypertension
Clinical Practice Guidelines Management of Hypertension Definition and classification of blood pressure levels (mmhg) Category Systolic Diastolic Normal
Drug-Induced Diabetes May Not Be Harmful But Should Be Prevented. Jeffrey A. Cutler, MD, MPH
Drug-Induced Diabetes May Not Be Harmful But Should Be Prevented Jeffrey A. Cutler, MD, MPH Overview Focus on thiazide-like diuretics (not BB) Diuretic-induced versus diureticassociated diabetes Role of
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,
Jackson T. Wright, Jr. MD, PhD
DIFFERENTIAL EFFECTS OF BLOOD PRESSURE MEDICATIONS IN BLACK PATIENTS Jackson T. Wright, Jr. MD, PhD Professor of Medicine Program Director, WT Dahms MD Clinical Research Unit Clinical and Translational
Is 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
VA/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,
In 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.
Diabetes 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
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%
Understanding 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,
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
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
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
First line treatment of primary hypertension
First line treatment of primary hypertension Dr. Vijaya Musini Assistant Professor, Dept. Anesthesiology, Pharmacology and Therapeutics Manager, Drug Assessment Working Group Therapeutics Initiative Editor,
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
Update 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
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
Cedars 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
The Antihypertensive and Lipid-Lowering Treatment to
Scientific Contributions Diuretic Versus -Blocker as First-Step Antihypertensive Therapy Final Results From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) ALLHAT
The Indian Polycap Study 1 & 2 (TIPS 1 & 2) and The International Polycap Study 3 & 4 (TIPS 3 & 4)
The Indian Polycap Study 1 & 2 (TIPS 1 & 2) and The International Polycap Study 3 & 4 (TIPS 3 & 4) Denis Xavier MD, MSc Professor and Head, Pharmacology, St. John's Medical College Coordinator, Division
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
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
Should we prescribe aspirin and statins to all subjects over 65? (Or even all over 55?) Terje R.Pedersen Oslo University Hospital Oslo, Norway
Should we prescribe aspirin and statins to all subjects over 65? (Or even all over 55?) Terje R.Pedersen Oslo University Hospital Oslo, Norway The Polypill A strategy to reduce cardiovascular disease by
Hypertension (JNC-8)
Hypertension (JNC-8) Southern California University of Health Sciences Physician Assistant Program Management and Treatment of Hypertension April 17, 2018, presented by Ezra Levy, Pharm.D.! The 8 th Joint
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
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
Improving Medical Statistics and Interpretation of Clinical Trials
Improving Medical Statistics and Interpretation of Clinical Trials 1 ALLHAT Trial & ALLHAT Meta-Analysis Critique Table of Contents ALLHAT Trial Critique- Overview p 2-4 Critique Of The Flawed Meta-Analysis
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
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
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
BLOOD 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
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
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
Hypertension 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
Hypertension 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
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
Hypertension: 2016 Clinical Update
PHASE Safety Net Community Benefit Hypertension: 2016 Clinical Update Presented by: Joseph Young, MD Hypertension Clinical Lead Kaiser Permanente Northern California October 6, 2016 Dr. Joseph Young Hypertension
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. Most important public health problem in developed countries
Hypertension Strategy for Continued Success in Treatment for the 21st Century November 15, 2005 Arnold B. Meshkov, M.D. Associate Professor of Medicine Temple University School of Medicine Philadelphia,
Systolic 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
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 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
Outcomes 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
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
Abbreviations 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
Role of Clopidogrel in Acute Coronary Syndromes. Hossam Kandil,, MD. Professor of Cardiology Cairo University
Role of Clopidogrel in Acute Coronary Syndromes Hossam Kandil,, MD Professor of Cardiology Cairo University ACS Treatment Strategies Reperfusion/Revascularization Therapy Thrombolysis PCI (with/ without
Clinical Trial - ALLHAT. Mortality and Morbidity During and After Antihypertensive. and Lipid-Lowering Treatment to Prevent Heart Attack Trial
Clinical Trial - ALLHAT Mortality and Morbidity During and After Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Results by Sex Suzanne Oparil, Barry R. Davis, William C. Cushman,
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
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.
ALLHAT and its implications in the diabetic population
SPECIAL REPORT ALLHAT and its implications in the diabetic population Samy I McFarlane, MD, MPH, FACP Associate Professor of Medicine, Fellowship Program Director, Division of Endocrinology, Diabetes and
Highlights 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
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 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
Update 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
2/10/2014. 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
VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION
VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION Dr Catherine BESEME Paris 6 th December 2005 6 th International Congress of Bangladesh Society of Medicine Hypertension is a risk factor at the source, with
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
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
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;
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
Combination 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
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
Hypertension 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
New 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
The CARI Guidelines Caring for Australians with Renal Impairment. Specific effects of calcium channel blockers in diabetic nephropathy GUIDELINES
Specific effects of calcium channel blockers in diabetic nephropathy Date written: September 2004 Final submission: September 2005 Author: Kathy Nicholls GUIDELINES a. Non-dihydropyridine calcium channel
Masked 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:
h i g h b l o o d p r e s s u r e
h i g h b l o o d p r e s s u r e where are we at? The recent literature has raised doubts about the role of ßblockers for lowering blood pressure and the New Zealand Guidelines Group is updating the Assessment
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,
2003 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
New 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
Large therapeutic studies in elderly patients with hypertension
(2002) 16 (Suppl 1), S38 S43 2002 Nature Publishing Group All rights reserved 0950-9240/02 $25.00 www.nature.com/jhh Large therapeutic studies in elderly patients with hypertension Centro Clinico Profesional
Management 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:
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
Causes of Poor BP control Rates
Goals Of Hypertension Management in Clinical Practice World Hypertension League (WHL) Meeting Adel E. Berbari, MD, FAHA, FACP Professor of Medicine and Physiology Head, Division of Hypertension and Vascular
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