Blood Pressure Targets: Where are We Now?

Size: px
Start display at page:

Download "Blood Pressure Targets: Where are We Now?"

Transcription

1

2 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

3 Disclosure I have no actual or potential conflict of interest in relation to this program.

4 Learning Objectives 1. Discuss guideline recommendations regarding blood pressure goals 2. Describe results from recent hypertension trials 3. Select appropriate blood pressure goals for patients with hypertension

5 Introduction Hypertension (HTN) is a major risk factor for cardiovascular (CV) diseases About one in three US adults has HTN $48.6 billion direct and indirect cost annually Increasing mortality from Approximately half hypertensives are under control Mozaffarian D, et. al. Heart disease and stroke statistics Circulation. 2016;133(4):e CDC. High blood pressure fact sheet. Retrieved from

6 Introduction Mozaffarian D, et. al. Heart disease and stroke statistics Circulation Jan 16;133(4):e38-60.

7 Guideline Recommendations JNC 8 (2014) ESH/ESC (2013) ASH/ISH (2014) General Population < 140/90 mm Hg < 140/90 mm Hg < 140/90 mm Hg Elderly Chronic Kidney Disease Older than 60 years of age < 150/90 mm Hg Younger than 80 years of age SBP mm Hg for most, may consider < 140 mm Hg in those who are fit DBP < 90 mm Hg Older than 80 years of age SBP mm Hg and DBP < 90 if in good physical and mental conditions < 140/90 mm Hg < 140/90 mm Hg (SBP < 130 mm Hg when overt proteinuria is present) Older than 80 years of age < 150/90 mm Hg unless chronic kidney disease or diabetes < 140/90 mm Hg Diabetes Mellitus < 140/90 mm Hg < 140/85 mm Hg < 140/90 mm Hg James PA, et. al Evidence-based guideline for the management of high blood pressure in adults. JAMA. 2014;311(5): Weber MA, et. al. Clinical practice guideline for the management of hypertension in the community. J Clin Hypertens. 2014;16(1): Mancia G, et. al ESH/ESC Practice guidelines for the management of arterial hypertension. Eur Heart J. 2013;34(28):

8 Recent Trials

9 SPRINT Systolic Blood Pressure Intervention Trial (SPRINT) SBP between mm Hg, age 50 years or greater, increased cardiovascular risk but without diabetes or stroke (N=9361) SBP target of < 120 mm Hg (N=4678) SBP target of < 140 mm Hg (N=4683) All major classes of antihypertensives used Primary outcome composite of myocardial infarction (MI), acute coronary syndrome (ACS) not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death from CV causes Median follow up 3.26 years Wright JT, et. al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015;373:

10 SPRINT Mean systolic blood pressure (SBP) at one year mm Hg in intensive-treatment group vs mm Hg in standard-treatment group 1.65% per year vs. 2.19% per year 1.03% per year vs. 1.40% per year Wright JT, et. al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015;373:

11 SPRINT No difference in the overall rates of serious adverse events (38.3% vs. 37.1%, HR 1.04, p=0.25) Serious adverse events possibly or definitely related to the intervention Higher rates in the intensive-treatment group (4.7% vs. 2.5%, HR 1.88, p<0.001) Hypotension (1.8% vs. 0.8%) Syncope (1.4% vs. 0.6%) Electrolyte abnormality (1.5% vs. 1.0%) Acute kidney injury (1.9% vs. 0.7%) Wright JT, et. al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015;373:

12 ACCORD BP Action to Control Cardiovascular Risk in Diabetes (ACCORD) Diabetic patients with SBP mm Hg, HgbA1c of 7.5% or more, lack of significant proteinuria, 40 years of age or older with CV disease or 55 years of age or older at high risk for CV disease (N=4733) All major antihypertensive classes used SBP target of < 120 mm Hg (N=2362) SBP target of < 140 mm Hg (N=2371) Primary outcome: composite of nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death Mean follow up 4.7 years Cushman WC, et. al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010;362:

13 SPRINT Systolic Blood Pressure Intervention Trial (SPRINT) SBP between mm Hg, age 50 years or greater, increased cardiovascular risk but without diabetes or stroke (N=9361) SBP target of < 120 mm Hg (N=4678) SBP target of < 140 mm Hg (N=4683) All major classes of antihypertensives used Primary outcome composite of myocardial infarction (MI), acute coronary syndrome (ACS) not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death from CV causes Median follow up 3.26 years Wright JT, et. al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015;373:

14 ACCORD BP Mean SBP at one year mm Hg in intensive treatment group vs mm Hg in standard treatment group HR= % per year vs. 2.09% per year 0.30% per year vs. 0.47% per year HR=0.63 Cushman WC, et. al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010;362:

15 ACCORD BP Serious adverse events attributed to antihypertensive treatment Higher rates in the intensive-treatment group (3.3% vs. 1.3%, p<0.001) Hypotension (0.7% vs. 0.04%) Syncope (0.5% vs. 0.21%) Bradycardia or arrhythmia (0.5% vs. 0.13%) Hyperkalemia (0.4% vs. 0.04%) Cushman WC, et. al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010;362:

16 SPRINT vs. ACCORD BP Sample size (9361 vs. 4733) Diabetes vs. no diabetes Blood pressure measurement technique Both used automated device Omron 907 (Omron Healthcare, Lake Forest, IL) Device takes three measurements after 5 minutes rest SPRINT measurements taken unattended vs. ACCORD BP measurements taken attended Kjeldsen, SE, et. al. Unattended blood pressure measurements in the systolic blood pressure intervention. Hypertension. 2016;67:

17 Blood Pressure Measurements (unattended) (attended) (unattended) Myers MG, et. al. Measurement of blood pressure in the office. Hypertension. 2010;55:

18 Blood Pressure Measurements (unattended) (attended) (unattended) Another recent study showed unattended office BP being 15 mm Hg lower than office BP Myers MG, et. al. Measurement of blood pressure in the office. Hypertension. 2010;55: Filipovsky J, et. al. Automated compared to manual office blood pressure and to home blood pressure in hypertensive patients. Blood Press. 2016;25:

19 HOPE-3 Heart Outcomes Prevention Evaluation-3 (HOPE-3) Men 55 years of age or older and women 60 years of age or older with CV risk factor(s) but no preexisting CV disease (N=14682) Randomized after 4- week run in (N=12705) Candesartan 16mg/day + HCTZ 12.5mg/day (N=6353) Placebo (N=6349) Co-primary endpoint Composite of death from CV causes, nonfatal MI, or nonfatal stroke Composite of above events plus resuscitated cardiac arrest, heart failure, or revascularization Median follow up 5.6 years Lonn EM, et. al. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 2016;374:

20 HOPE-3 Mean systolic blood pressure (SBP) mm Hg in intervention group vs mm Hg in placebo group Outcome Active Treatment Placebo HR (95% CI) P-value 1 st co-primary outcome 260 (4.1) 279 (4.4) 0.93 ( ) nd co-primary outcome 312 (4.9) 328 (5.2) 0.95 ( ) 0.51 Total stroke 75 (1.2) 94 (1.5) 0.80 ( ) 0.14 Total MI 52 (0.8) 62 (1.0) 0.84 ( ) 0.34 Death from any cause 342 (5.4) 349 (5.5) 0.98 ( ) 0.78 CV death 155 (2.4) 170 (2.7) 0.91 ( ) 0.40 Heart failure 21 (0.3) 29 (0.5) 0.72 ( ) 0.26 Lonn EM, et. al. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 2016;374:

21 HOPE-3 Lonn EM, et. al. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 2016;374:

22 HOPE-3 No difference in the rates of adverse events leading to permanent study drug discontinuation (24.4% vs. 25.2%, p=0.33) Dizziness/lightheadedness/hypotension (3.4% vs. 2.0%, p<0.0001) Higher rates of adverse events leading to temporary study drug discontinuation in the active treatment group (26.0% vs. 24.4%, p=0.04) Dizziness/lightheadedness/hypotension (2.7% vs. 1.3%, p<0.0001) Lonn EM, et. al. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 2016;374:

23 HOPE-3 vs. SPRINT Trial Characteristics HOPE-3 SPRINT Trial design Fixed-dose regimen vs. placebo Intensive vs. standard BP control Participant recruitment International United States Racial distribution 49% Asian, 28% Hispanics, 20% White 58% White, 30% Black, 11% Hispanics CV risk Lower Higher Blood pressure measurement Automated, attended Automated, unattended SBP difference 6.0 mm Hg 14.8 mm Hg Primary endpoint 1 st co-primary: HR 0.93, 95% CI nd co-primary: HR 0.95, 95% CI HR 0.75, 95% CI Wright JT, et. al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015;373: Lonn EM, et. al. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 2016;374: Kjeldsen, SE, et. al. Unattended blood pressure measurements in the systolic blood pressure intervention. Hypertension. 2016;67: Lonn EM, et. al. Novel approaches in primary cardiovascular disease prevention: the HOPE-3 trial rationale, design, and participants baseline characteristics. Can J Cardiol 2016;32:311-8

24 What Did We Learn? Insufficient evidence to deviate from SBP goal of < 140 mm Hg set forth by the guideline General population with no DM or CKD Manual or automated office BP measurements Lower on-treatment SBP is associated with increased adverse events Hypotension Syncope Electrolyte abnormalities

25 Guideline Recommendations JNC 8 (2014) ESH/ESC (2013) ASH/ISH (2014) General Population < 140/90 mm Hg < 140/90 mm Hg < 140/90 mm Hg Elderly Chronic Kidney Disease Older than 60 years of age < 150/90 mm Hg Younger than 80 years of age SBP mm Hg for most, may consider < 140 mm Hg in those who are fit DBP < 90 mm Hg Older than 80 years of age SBP mm Hg and DBP < 90 if in good physical and mental conditions < 140/90 mm Hg < 140/90 mm Hg (SBP < 130 mm Hg when overt proteinuria is present) Older than 80 years of age < 150/90 mm Hg unless chronic kidney disease or diabetes < 140/90 mm Hg Diabetes Mellitus < 140/90 mm Hg < 140/85 mm Hg < 140/90 mm Hg James PA, et. al Evidence-based guideline for the management of high blood pressure in adults. JAMA. 2014;311(5): Weber MA, et. al. Clinical practice guideline for the management of hypertension in the community. J Clin Hypertens. 2014;16(1): Mancia G ESH/ESC Practice guidelines for the management of arterial hypertension. Eur Heart J. 2013;34(28):

26 Trial (Year of Publication) Age for Inclusion Intervention Control Achieved BP Composite CVD Total Stroke All-Cause Mortality CV Mortality SHEP (1991) 60 or older Chlorthalidonebased regimen Placebo Intervention: 143/68 mm Hg Placebo: 155/72 mm Hg RR=0.68 (0.58 to 0.79) RR=0.64 (0.50 to 0.82) RR=0.87 (0.73 to 1.05) RR=0.80 (0.60 to 1.05) STOP- Hypertension (1991) Beta-blocker or diuretic-based regimens Placebo Intervention: 167/87 mm Hg Placebo: 186/96 mm Hg RR=0.60 (0.43 to 0.85) RR=0.53 (0.33 to 0.86) RR=0.57 (0.37 to 0.87) Fatal MI, stroke, sudden death, and other CV death: 17 vs. 41 cases MRC-OA (1992) Beta-blocker or diuretic-based regimens Placebo Intervention: ~150/77 (est) Placebo: ~163/83 (est) RRR=17% (2% to 29%) RRR=25% (3% to 42%) RRR=3% (-14% to 18%) RRR=9% (-12% to 27%) Syst-Eur (1997) 60 or older Nitrendipinebased regimen Placebo Intervention: 151/79 mm Hg Placebo: 161/84 mm Hg RRR=31% (p<0.001) RRR=42% (p=0.003) RRR=14% (P=0.22) RRR=27% (P=0.07) Syst-China (1998) 60 or older Nitrendipinebased regimen Placebo Intervention: 151/81 mm Hg Placebo: 159/84 mm Hg RRR=37% (p=0.004) RRR=38% (p=0.01) RRR=39% (p=0.003) RRR=39% (p=0.03) HYVET (2008) 80 or older Indapamidebased regimen Placebo Intervention: 144/78 mm Hg Placebo: 159/84 mm Hg HR=0.66 (p<0.001) HR=0.70 (p=0.06) HR=0.79 (p=0.02) HR=0.77 (p=0.06) JATOS (2008) 65 to 85 Efonidipinebased regimen SBP < 140 mm Hg Efonidipinebased regimen SBP mm Hg Strict control: 136/75 mm Hg Mild control: 146/78 mm Hg 1.18% vs. 1.27% (p=0.78) 2.35% vs. 2.22% (p=0.77) 2.44% vs. 1.90% (p=0.22) 0.27% vs. 0.18% (p=0.53) VALISH (2010) 70 to 84 Valsartan-based regimen SBP < 140 mm Hg Valsartan-based regimen SBP mm Hg Strict control: 137/75 mm Hg Mild control: 142/77 mm Hg HR=0.89 ( ) HR=0.68 ( ) HR=0.78 ( ) HR=0.97 ( )

27 Trial (Year of Publication) Age for Inclusion Intervention Control Achieved BP Composite CVD Total Stroke All-Cause Mortality CV Mortality SHEP (1991) 60 or older Chlorthalidonebased regimen Placebo Intervention: 143/68 mm Hg Placebo: 155/72 mm Hg RR=0.68 (0.58 to 0.79) RR=0.64 (0.50 to 0.82) RR=0.87 (0.73 to 1.05) RR=0.80 (0.60 to 1.05) STOP- Hypertension (1991) Beta-blocker or diuretic-based regimens Placebo Intervention: 167/87 mm Hg Placebo: 186/96 mm Hg RR=0.60 (0.43 to 0.85) RR=0.53 (0.33 to 0.86) RR=0.57 (0.37 to 0.87) Fatal MI, stroke, sudden death, and other CV death: 17 vs. 41 cases MRC-OA (1992) Beta-blocker or diuretic-based regimens Placebo Intervention: ~150/77 (est) Placebo: ~163/83 (est) RRR=17% (2% to 29%) RRR=25% (3% to 42%) RRR=3% (-14% to 18%) RRR=9% (-12% to 27%) Syst-Eur (1997) 60 or older Nitrendipinebased regimen Placebo Intervention: 151/79 mm Hg Placebo: 161/84 mm Hg RRR=31% (p<0.001) RRR=42% (p=0.003) RRR=14% (P=0.22) RRR=27% (P=0.07) Syst-China (1998) 60 or older Nitrendipinebased regimen Placebo Intervention: 151/81 mm Hg Placebo: 159/84 mm Hg RRR=37% (p=0.004) RRR=38% (p=0.01) RRR=39% (p=0.003) RRR=39% (p=0.03) HYVET (2008) 80 or older Indapamidebased regimen Placebo Intervention: 144/78 mm Hg Placebo: 159/84 mm Hg HR=0.66 (p<0.001) HR=0.70 (p=0.06) HR=0.79 (p=0.02) HR=0.77 (p=0.06) JATOS (2008) 65 to 85 Efonidipinebased regimen SBP < 140 mm Hg Efonidipinebased regimen SBP mm Hg Strict control: 136/75 mm Hg Mild control: 146/78 mm Hg 1.18% vs. 1.27% (p=0.78) 2.35% vs. 2.22% (p=0.77) 2.44% vs. 1.90% (p=0.22) 0.27% vs. 0.18% (p=0.53) VALISH (2010) 70 to 84 Valsartan-based regimen SBP < 140 mm Hg Valsartan-based regimen SBP mm Hg Strict control: 137/75 mm Hg Mild control: 142/77 mm Hg HR=0.89 ( ) HR=0.68 ( ) HR=0.78 ( ) HR=0.97 ( )

28 Trial (Year of Publication) Age for Inclusion Intervention Control Achieved BP Composite CVD Total Stroke All-Cause Mortality CV Mortality SHEP (1991) 60 or older Chlorthalidonebased regimen Placebo Intervention: 143/68 mm Hg Placebo: 155/72 mm Hg RR=0.68 (0.58 to 0.79) RR=0.64 (0.50 to 0.82) RR=0.87 (0.73 to 1.05) RR=0.80 (0.60 to 1.05) STOP- Hypertension (1991) Beta-blocker or diuretic-based regimens Placebo Intervention: 167/87 mm Hg Placebo: 186/96 mm Hg RR=0.60 (0.43 to 0.85) RR=0.53 (0.33 to 0.86) RR=0.57 (0.37 to 0.87) Fatal MI, stroke, sudden death, and other CV death: 17 vs. 41 cases MRC-OA (1992) Beta-blocker or diuretic-based regimens Placebo Intervention: ~150/77 (est) Placebo: ~163/83 (est) RRR=17% (2% to 29%) RRR=25% (3% to 42%) RRR=3% (-14% to 18%) RRR=9% (-12% to 27%) Syst-Eur (1997) 60 or older Nitrendipinebased regimen Placebo Intervention: 151/79 mm Hg Placebo: 161/84 mm Hg RRR=31% (p<0.001) RRR=42% (p=0.003) RRR=14% (P=0.22) RRR=27% (P=0.07) Syst-China (1998) 60 or older Nitrendipinebased regimen Placebo Intervention: 151/81 mm Hg Placebo: 159/84 mm Hg RRR=37% (p=0.004) RRR=38% (p=0.01) RRR=39% (p=0.003) RRR=39% (p=0.03) HYVET (2008) 80 or older Indapamidebased regimen Placebo Intervention: 144/78 mm Hg Placebo: 159/84 mm Hg HR=0.66 (p<0.001) HR=0.70 (p=0.06) HR=0.79 (p=0.02) HR=0.77 (p=0.06) JATOS (2008) 65 to 85 Efonidipinebased regimen SBP < 140 mm Hg Efonidipinebased regimen SBP mm Hg Strict control: 136/75 mm Hg Mild control: 146/78 mm Hg 1.18% vs. 1.27% (p=0.78) 2.35% vs. 2.22% (p=0.77) 2.44% vs. 1.90% (p=0.22) 0.27% vs. 0.18% (p=0.53) VALISH (2010) 70 to 84 Valsartan-based regimen SBP < 140 mm Hg Valsartan-based regimen SBP mm Hg Strict control: 137/75 mm Hg Mild control: 142/77 mm Hg HR=0.89 ( ) HR=0.68 ( ) HR=0.78 ( ) HR=0.97 ( )

29 Trial (Year of Publication) Age for Inclusion Intervention Control Achieved BP Composite CVD Total Stroke All-Cause Mortality CV Mortality SHEP (1991) 60 or older Chlorthalidonebased regimen Placebo Intervention: 143/68 mm Hg Placebo: 155/72 mm Hg RR=0.68 (0.58 to 0.79) RR=0.64 (0.50 to 0.82) RR=0.87 (0.73 to 1.05) RR=0.80 (0.60 to 1.05) STOP- Hypertension (1991) Beta-blocker or diuretic-based regimens Placebo Intervention: 167/87 mm Hg Placebo: 186/96 mm Hg RR=0.60 (0.43 to 0.85) RR=0.53 (0.33 to 0.86) RR=0.57 (0.37 to 0.87) Fatal MI, stroke, sudden death, and other CV death: 17 vs. 41 cases MRC-OA (1992) Beta-blocker or diuretic-based regimens Placebo Intervention: ~150/77 (est) Placebo: ~163/83 (est) RRR=17% (2% to 29%) RRR=25% (3% to 42%) RRR=3% (-14% to 18%) RRR=9% (-12% to 27%) Syst-Eur (1997) 60 or older Nitrendipinebased regimen Placebo Intervention: 151/79 mm Hg Placebo: 161/84 mm Hg RRR=31% (p<0.001) RRR=42% (p=0.003) RRR=14% (P=0.22) RRR=27% (P=0.07) Syst-China (1998) 60 or older Nitrendipinebased regimen Placebo Intervention: 151/81 mm Hg Placebo: 159/84 mm Hg RRR=37% (p=0.004) RRR=38% (p=0.01) RRR=39% (p=0.003) RRR=39% (p=0.03) HYVET (2008) 80 or older Indapamidebased regimen Placebo Intervention: 144/78 mm Hg Placebo: 159/84 mm Hg HR=0.66 (p<0.001) HR=0.70 (p=0.06) HR=0.79 (p=0.02) HR=0.77 (p=0.06) JATOS (2008) 65 to 85 Efonidipinebased regimen SBP < 140 mm Hg Efonidipinebased regimen SBP mm Hg Strict control: 136/75 mm Hg Mild control: 146/78 mm Hg 1.18% vs. 1.27% (p=0.78) 2.35% vs. 2.22% (p=0.77) 2.44% vs. 1.90% (p=0.22) 0.27% vs. 0.18% (p=0.53) VALISH (2010) 70 to 84 Valsartan-based regimen SBP < 140 mm Hg Valsartan-based regimen SBP mm Hg Strict control: 137/75 mm Hg Mild control: 142/77 mm Hg HR=0.89 ( ) HR=0.68 ( ) HR=0.78 ( ) HR=0.97 ( )

30 JNC 8 Recommendation James PA, et. al Evidence-based guideline for the management of high blood pressure in adults. JAMA. 2014;311(5):

31 Hazard ratio SPRINT CV 1⁰ outcome All-cause mortality CV mortality Heart failure Stroke* Overall Age 75 Wright JT, et. al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015;373: Williamson JD, et. al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged 75 years. JAMA 2016;315:

32 HOPE-3 First Co-Primary Outcome Lonn EM, et. al. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 2016;374:

33 HOPE-3 Second Co-Primary Outcome Lonn EM, et. al. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 2016;374:

34 What SBP Goal Would You Like to Recommend for Elderly Hypertensives? A. < 150 mm Hg B. < 140 mm Hg C. < 120 mm Hg D. There are more factors to consider

35 What Else? BP measurement technique Comorbid conditions Risk for adverse reactions Frailty

36 Blood Pressure Measurements (unattended) (attended) (unattended) Myers MG, et. al. Measurement of blood pressure in the office. Hypertension. 2010;55:

37 Comorbid Conditions Diabetes mellitus Chronic kidney disease Stroke/transient ischemic attack Peripheral artery disease Metabolic syndrome Coronary heart disease Heart failure

38 Risk for Adverse Events Advanced Age Comorbidities Medications Adverse Events

39 Percentage Percentage Percentage Percentage Percentage Risk for Adverse Events Serious Adverse Events (SAE) Intensive Treatment Standard Treatment Overall Age Hypotension (SAE) Intensive Standard Electrolyte Abnormalities (SAE) Intensive Standard Wright JT, et. al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015;373: Williamson JD, et. al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged 75 years. JAMA 2016;315: Syncope (SAE) Intensive Standard Acute Kidney Injury (SAE) Intensive Standard

40 Percentage Frailty Serious Adverse Events Fit Less Fit Frail Intensive Treatment Standard Treatment Williamson JD, et. al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged 75 years. JAMA 2016;315:

41 Percentage Frailty Cardiovascular events Fit Less Fit Frail Intensive Treatment Standard Treatment Williamson JD, et. al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged 75 years. JAMA 2016;315:

42 Summary SBP goal < 140 mm Hg (measured attended) is reasonable for the general population SBP goal of < 140 mm Hg (measured attended) is reasonable for elderly patients Risk vs. benefit for each individual patient Goal may be loosened for patients at high risk for adverse events The exact difference between manual office BP, attended automated blood pressure, and unattended automated blood pressure requires further research Intense monitoring for frail elderly

43 Test Questions 1. According to JNC 8, general population aged 60 years should be treated to a SBP goal of a. < 120 mm Hg b. < 130 mm Hg c. < 140 mm Hg d. < 150 mm Hg 2. True or False. In the SPRINT trial, targeting a SBP of < 120 mm Hg, as compared with < 140 mm Hg, resulted in lower rates of cardiovascular events. a. True b. False 3. Which of the following factor(s) would be important to consider in determining a SBP target for an elderly patient? a. Frailty b. Comorbid condition c. Risk for adverse events d. BP measuring technique e. All of the above

44 Test Questions 1. According to JNC 8, general population aged 60 years should be treated to a SBP goal of a. < 120 mm Hg b. < 130 mm Hg c. < 140 mm Hg d. < 150 mm Hg 2. True or False. In the SPRINT trial, targeting a SBP of < 120 mm Hg, as compared with < 140 mm Hg, resulted in lower rates of cardiovascular events. a. True b. False 3. Which of the following factor(s) would be important to consider in determining a SBP target for an elderly patient? a. Frailty b. Comorbid condition c. Risk for adverse events d. BP measuring technique e. All of the above

45 Test Questions 1. According to JNC 8, general population aged 60 years should be treated to a SBP goal of a. < 120 mm Hg b. < 130 mm Hg c. < 140 mm Hg d. < 150 mm Hg 2. True or False. In the SPRINT trial, targeting a SBP of < 120 mm Hg, as compared with < 140 mm Hg, resulted in lower rates of cardiovascular events. a. True b. False 3. Which of the following factor(s) would be important to consider in determining a SBP target for an elderly patient? a. Frailty b. Comorbid condition c. Risk for adverse events d. BP measuring technique e. All of the above

46 Test Questions 1. According to JNC 8, general population aged 60 years should be treated to a SBP goal of a. < 120 mm Hg b. < 130 mm Hg c. < 140 mm Hg d. < 150 mm Hg 2. True or False. In the SPRINT trial, targeting a SBP of < 120 mm Hg, as compared with < 140 mm Hg, resulted in lower rates of cardiovascular events. a. True b. False 3. Which of the following factor(s) would be important to consider in determining a SBP target for an elderly patient? a. Frailty b. Comorbid condition c. Risk for adverse events d. BP measuring technique e. All of the above

47 References Mozaffarian D, et. al. Heart disease and stroke statistics Circulation. 2016;133(4):e CDC. High blood pressure fact sheet. Retrieved from James PA, et. al Evidence-based guideline for the management of high blood pressure in adults. JAMA. 2014;311(5): Weber MA, et. al. Clinical practice guideline for the management of hypertension in the community. J Clin Hypertens. 2014;16(1): Mancia G, et. al ESH/ESC Practice guidelines for the management of arterial hypertension. Eur Heart J. 2013;34(28): Wright JT, et. al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015;373: Cushman WC, et. al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010;362: Kjeldsen, SE, et. al. Unattended blood pressure measurements in the systolic blood pressure intervention. Hypertension. 2016;67: Lonn EM, et. al. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 2016;374: Lonn EM, et. al. Novel approaches in primary cardiovascular disease prevention: the HOPE-3 trial rationale, design, and participants baseline characteristics. Can J Cardiol 2016;32:311-8 Beckett NS, et. al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008;358:

48 References Staessen JA, et. al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997;350: SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1991;265: Ogihara T, et. al. Target blood pressure for treatment of isolated systolic hypertension in the elderly. Hypertension 2010;56: JATOS study group. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res 2008;31: Dahlof B, et. al. Morbidity and mortality in the Swedish trial in old patients with hypertension (STOP-Hypertension). Lancet 1991;338: MRC Working Party. Medical research council trial of treatment of hypertension in older adults: principal results. BMJ 1992;304: Williamson JD, et. al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged 75 years. JAMA 2016;315: Myers MG, et. al. Measurement of blood pressure in the office. Hypertension. 2010;55: Filipovsky J, et. al. Automated compared to manual office blood pressure and to home blood pressure in hypertensive patients. Blood Press. 2016;25:

49

50 Session Code: 1. Write down the course code. Space has been provided in the daily program-at-aglance sections of your program book. 2. To claim credit: Go to before December 1, 2016.

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 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 information

Objectives. Describe results and implications of recent landmark hypertension trials

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

More information

Hypertension Update Clinical Controversies Regarding Age and Race

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 information

JNC 8 -Controversies. Sagren Naidoo Nephrologist CMJAH

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

More information

Treating Hypertension in 2018: What Makes the Most Sense Today?

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

More information

Blood Pressure Treatment Goals

Blood Pressure Treatment Goals Blood Pressure Treatment Goals Kenneth Izuora, MD, MBA, FACE Associate Professor UNLV School of Medicine November 18, 2017 Learning Objectives Discuss the recent studies on treating hypertension Review

More information

The earlier BP control the better cardiovascular outcome. Jin Oh Na Cardiovascular center Korea University Medical College

The earlier BP control the better cardiovascular outcome. Jin Oh Na Cardiovascular center Korea University Medical College The earlier BP control the better cardiovascular outcome Jin Oh Na Cardiovascular center Korea University Medical College Index Introduction HOPE-3 Trial Sprint Study Summary Each 2 mmhg decrease in SBP

More information

T. Suithichaiyakul Cardiomed Chula

T. 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 information

Chapman University Digital Commons. Chapman University. Michael S. Kelly Chapman University,

Chapman 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 information

Hypertension Controversies: SPRINTing to New Goals

Hypertension 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 information

Hypertension and the SPRINT Trial: Is Lower Better

Hypertension 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 information

4/4/17 HYPERTENSION TARGETS: WHAT DO WE DO NOW? SET THE STAGE BP IN CLINICAL TRIALS?

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

More information

HYPERTENSION MANAGEMENT IN ELDERLY POPULATIONS

HYPERTENSION 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 information

Hypertension Management: A Moving Target

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,

More information

HYPERTENSION GUIDELINES WHERE ARE WE IN 2014

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

More information

Managing HTN in the Elderly: How Low to Go

Managing HTN in the Elderly: How Low to Go Managing HTN in the Elderly: How Low to Go Laxmi S. Mehta, MD, FACC The Ohio State University Medical Center Assistant Professor of Clinical Internal Medicine Clinical Director of the Women s Cardiovascular

More information

Hypertension and Diabetes Should we be SPRINTING or Reaching an ACCORD?

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

More information

New 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 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 information

Int. J. Pharm. Sci. Rev. Res., 36(1), January February 2016; Article No. 06, Pages: JNC 8 versus JNC 7 Understanding the Evidences

Int. 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 information

DISCLOSURE PHARMACIST OBJECTIVES 9/30/2014 JNC 8: A REVIEW OF THE LONG-AWAITED/MUCH-ANTICIPATED HYPERTENSION GUIDELINES. I have nothing to disclose.

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

More information

Hypertension Update 2016 AREEF ISHANI, MD MS CHIEF OF MEDICINE MINNEAPOLIS VA MEDICAL CENTER PROFESSOR OF MEDICINE UNIVERSITY OF MINNESOTA

Hypertension Update 2016 AREEF ISHANI, MD MS CHIEF OF MEDICINE MINNEAPOLIS VA MEDICAL CENTER PROFESSOR OF MEDICINE UNIVERSITY OF MINNESOTA Hypertension Update 2016 AREEF ISHANI, MD MS CHIEF OF MEDICINE MINNEAPOLIS VA MEDICAL CENTER PROFESSOR OF MEDICINE UNIVERSITY OF MINNESOTA Case 1 What should be your BP goal for an elderly (> 75 yrs of

More information

2/10/2014. Hypertension: Highlights of Hypertension Guidelines: Making the Most of Limited Evidence. Issues with contemporary guidelines

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

More information

Don t let the pressure get to you:

Don t let the pressure get to you: Balanced information for better care Don t let the pressure get to you: Current evidence-based goals for treating hypertension A cornerstone of primary care: Lowering high blood pressure prevents cardiovascular

More information

Disclosures. Hypertension: Nationwide Dilemma. Learning Objectives. What s Currently Recommended? Specific Concerns 3/9/2012

Disclosures. 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 information

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, 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 information

We are delighted to have Dr. Roetzheim with us today to discuss Managing Hypertension in Older Adult Patients.

We 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 information

Managing Hypertension in 2016

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

More information

Hypertension in Geriatrics. Dr. Allen Liu Consultant Nephrologist 10 September 2016

Hypertension in Geriatrics. Dr. Allen Liu Consultant Nephrologist 10 September 2016 Hypertension in Geriatrics Dr. Allen Liu Consultant Nephrologist 10 September 2016 Annual mortality (%) Cardiovascular Mortality Rates are Higher among Dialysis Patients 100 10 1 0.1 0.01 0.001 25-34

More information

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? 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 information

Implementation 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 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 information

Hypertension Update. Mayo Clinic 90 th Annual Clinical Reviews November 2 nd and 16 th, 2016

Hypertension Update. Mayo Clinic 90 th Annual Clinical Reviews November 2 nd and 16 th, 2016 Mayo Clinic 90 th Annual Clinical Reviews November 2 nd and 16 th, 2016 Hypertension Update Vincent J. Canzanello, M.D. Consultant, Division of Nephrology and Hypertension Professor or Medicine College

More information

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 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 information

Recent Hypertension Guidelines

Recent 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 information

Modern Management of Hypertension: Where Do We Draw the Line?

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

More information

Hypertension Management Controversies in the Elderly Patient

Hypertension Management Controversies in the Elderly Patient Hypertension Management Controversies in the Elderly Patient Juan Bowen, MD Geriatric Update for the Primary Care Provider November 17, 2016 2016 MFMER slide-1 Disclosure No financial relationships No

More information

Συμπεράσματα από τις νέες μελέτες για την αρτηριακή υπέρταση (SPRINT,PATHAY 2,HOPE 3)

Συμπεράσματα από τις νέες μελέτες για την αρτηριακή υπέρταση (SPRINT,PATHAY 2,HOPE 3) Συμπεράσματα από τις νέες μελέτες για την αρτηριακή υπέρταση (SPRINT,PATHAY 2,HOPE 3) Χάρης Γράσσος MD,FESC,PhD,EHS Διευθυντής Καρδιολόγος Γ.Ν.Α ΚΑΤ Visiting Professor University of Bolton U.K New England

More information

HYPERTENSION: UPDATE 2018

HYPERTENSION: UPDATE 2018 HYPERTENSION: UPDATE 2018 From the Cardiologist point of view Richard C Padgett, MD I have no disclosures HYPERTENSION ALWAYS THE ELEPHANT IN THE EXAM ROOM BUT SOMETIMES IT CHARGES HTN IN US ~78 million

More information

Modern Management of Hypertension

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

More information

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 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 information

, 13TH EUGMS CONGRESS NICE GOALS OF ANTIHYPERTENSIVE TREATMENT IN THE FRAIL IS SPRINT APPLICABLE? CONTRA

, 13TH EUGMS CONGRESS NICE GOALS OF ANTIHYPERTENSIVE TREATMENT IN THE FRAIL IS SPRINT APPLICABLE? CONTRA 21.09.2017, 13TH EUGMS CONGRESS NICE GOALS OF ANTIHYPERTENSIVE TREATMENT IN THE FRAIL IS SPRINT APPLICABLE? CONTRA Prof. Dr. Ute Hoffmann Klinik für Allgemeine Innere Medizin und Geriatrie Nephrologie/Angiologie/Diabetologie/Endokrinologie

More information

Preventing and Treating High Blood Pressure

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

More information

New Lipid Guidelines. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids.

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

More information

Evaluation and Management of Hypertension in Women. Vesna D. Garovic, M.D. Moscow, Russia, December 2016

Evaluation and Management of Hypertension in Women. Vesna D. Garovic, M.D. Moscow, Russia, December 2016 Evaluation and Management of Hypertension in Women Vesna D. Garovic, M.D. Moscow, Russia, December 2016 2016 MFMER 3508058-1 Women are not small men There is nothing as powerful as an idea whose time has

More information

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

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.

More information

Blood Pressure Targets in Diabetes

Blood 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 information

Blood Pressure Measurement in SPRINT

Blood Pressure Measurement in SPRINT Blood Pressure Measurement in SPRINT Karen C. Johnson, MD, MPH, FAHA Vice Chair, SPRINT Steering Committee University of Tennessee Health Science Center, Department of Preventive Medicine For the SPRINT

More information

Impact of Hypertension Threshold and Goals on Special Populations

Impact of Hypertension Threshold and Goals on Special Populations Impact of Hypertension Threshold and Goals on Special Populations National Lipid Association 2015 Annual Scientific Sessions June 13,2015 Keith C. Ferdinand, MD, FACC,FAHA,FASH,FNLA Professor of Clinical

More information

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 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 information

Treating Hypertension in Individuals with Diabetes

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

More information

Evolving 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) 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 information

Difficult to Treat Hypertension

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

More information

Large therapeutic studies in elderly patients with hypertension

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

More information

2014 HYPERTENSION GUIDELINES

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

More information

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 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 information

Managing Hypertension in 2018

Managing 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 information

Which 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 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 information

Systolic Blood Pressure Intervention Trial (SPRINT)

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

More information

Hypertension 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 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 information

The Latest Generation of Clinical

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

More information

Blood Pressure LIMBO How Low To Go?

Blood 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 information

ADVANCES IN MANAGEMENT OF HYPERTENSION

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%

More information

Blood pressure treatment target in diabetes. Should it be <130 mmhg?

Blood pressure treatment target in diabetes. Should it be <130 mmhg? Blood pressure treatment target in diabetes Should it be

More information

Conflicts 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? 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 information

Hypertension and Cardiovascular Disease

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,

More information

Objective & Outline. How the JNC Process Has Evolved. Expertise Represented on JNC 8 Panel

Objective & 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 information

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 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 information

Diabetes and Hypertension

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

More information

Abbreviations Cardiology I

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

More information

Go low or no? Managing blood pressure in primary care. Hypertension is rarely an isolated risk factor

Go low or no? Managing blood pressure in primary care. Hypertension is rarely an isolated risk factor Cardiovascular system DEBATE Go low or no? Managing blood pressure in primary care There is much debate as to whether intensive blood pressure management, i.e. aiming for a systolic blood pressure less

More information

Conflicts 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? 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 information

Cedars Sinai Diabetes. Michael A. Weber

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

More information

Hypertension Update 2009

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

More information

The New Hypertension Guidelines

The New Hypertension Guidelines The New Hypertension Guidelines Joseph Saseen, PharmD Professor and Vice Chair, Department of Clinical Pharmacy University of Colorado Anschutz Medical Campus Disclosure Joseph Saseen reports no conflicts

More information

How do we diagnose hypertension today? Presentation Subtitle

How do we diagnose hypertension today? Presentation Subtitle How do we diagnose hypertension today? Presentation Subtitle Renata Cífková Case 1 JM, a 64-year-old lady referred to our center because of undesirable effects of her antihypertensive medication Personal

More information

Rationale for the use of Single Pill Combination (SPC) and Asian data of ARB/CCB SPC

Rationale for the use of Single Pill Combination (SPC) and Asian data of ARB/CCB SPC Rationale for the use of Single Pill Combination (SPC) and Asian data of ARB/CCB SPC Seung Woo Park, MD Samsung Medical Center BP Control Rates in Asia BP controlled BP uncontrolled 24.3% 36.6% 19% Turkey

More information

Slide notes: References:

Slide notes: References: 1 2 3 Cut-off values for the definition of hypertension are systolic blood pressure (SBP) 135 and/or diastolic blood pressure (DBP) 85 mmhg for home blood pressure monitoring (HBPM) and daytime ambulatory

More information

Implications of Drug-related Increases in Blood Pressure

Implications of Drug-related Increases in Blood Pressure Implications of Drug-related Increases in Blood Pressure Preston M. Dunnmon, MD, FACP, FACC Division of Cardiovascular and Renal Products US Food and Drug Administration July 18, 2012 Disclaimer The findings

More information

New Antihypertensive Strategies to Improve Blood Pressure Control

New Antihypertensive Strategies to Improve Blood Pressure Control New Antihypertensive Strategies to Improve Blood Pressure Control Antonio Coca, MD, PhD,, FRCP, FESC Hypertension and Vascular Risk Unit Department of Internal Medicine. Hospital Clínic (IDIBAPS) University

More information

Management of Lipid Disorders and Hypertension: Implications of the New Guidelines

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

More information

Talking about 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

More information

Yuqing Zhang, M.D., FESC Department of Cardiology, Fu Wai Hospital. CAMS & PUMC, Beijing, China

Yuqing Zhang, M.D., FESC Department of Cardiology, Fu Wai Hospital. CAMS & PUMC, Beijing, China What Can We Learn from the Observational Studies and Clinical Trials of Prehypertension? Yuqing Zhang, M.D., FESC Department of Cardiology, Fu Wai Hospital. CAMS & PUMC, Beijing, China At ARIC visit 4

More information

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 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 information

Hypertension Management: Making Sense of Guidelines and Therapy Options for the Elderly

Hypertension Management: Making Sense of Guidelines and Therapy Options for the Elderly Butler University Digital Commons @ Butler University Scholarship and Professional Work COPHS College of Pharmacy & Health Sciences 2015 Hypertension Management: Making Sense of Guidelines and Therapy

More information

How clinically important are the results of the large trials in hypertension?

How clinically important are the results of the large trials in hypertension? How clinically important are the results of the large trials in hypertension? Stéphane LAURENT, MD, PhD, FESC Pharmacology Department and PARCC / INSERM U970 Hôpital Européen Georges Pompidou, Université

More information

TREATMENT OF GERIATRIC HYPERTENSION: THE SPRINT TRIAL AND RECENT GUIDELINES

TREATMENT OF GERIATRIC HYPERTENSION: THE SPRINT TRIAL AND RECENT GUIDELINES Treatment of Geriatric Hypertension: the SPRINT Trial and the Evolving Systolic Blood Pressure Target TREATMENT OF GERIATRIC HYPERTENSION: THE SPRINT TRIAL AND RECENT GUIDELINES MARK A. SUPIANO, M.D. PROFESSOR

More information

ADVANCES IN MANAGEMENT OF HYPERTENSION

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,

More information

김광일 서울대학교의과대학내과학교실 분당서울대학교병원내과

김광일 서울대학교의과대학내과학교실 분당서울대학교병원내과 치매예방을위한만성질환관리전략 김광일 서울대학교의과대학내과학교실 분당서울대학교병원내과 A sharp rise in the death rate from Alzheimer s disease Ivan Casserly & Eric Topol, Lancet 2004 Potential for primary prevention of Alzheimer s disease Alzheimer

More information

Managing Hypertension in Diabetes Sean Stewart, PharmD, BCPS, BCACP, CLS Internal Medicine Park Nicollet Clinic St Louis Park.

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

More information

Long-Term Care Updates

Long-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 information

Using the New Hypertension Guidelines

Using 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 information

What s In the New Hypertension Guidelines?

What s In the New Hypertension Guidelines? American College of Physicians Ohio/Air Force Chapters 2018 Scientific Meeting Columbus, OH October 5, 2018 What s In the New Hypertension Guidelines? Max C. Reif, MD, FACP Objectives: At the end of the

More information

Hypertension in the very old. Objectives: Clinical Perspective

Hypertension in the very old. Objectives: Clinical Perspective Harvard Medical School Hypertension in the very old Ihab Hajjar, MD, MS, AGSF Associate Director, CV Research Lab Assistant Professor of Medicine, Harvard Medical School Objectives: Describe the clinical

More information

Dr. Khan Abul Kalam Azad Associate Professor Department of Medicine SZRMC, Bogra

Dr. Khan Abul Kalam Azad Associate Professor Department of Medicine SZRMC, Bogra Dr. Khan Abul Kalam Azad Associate Professor Department of Medicine SZRMC, Bogra Beta-blockers were used in several longterm morbidity and trials in the treatment of hypertension, either alone or in comparison

More information

The Failing Heart in Primary Care

The Failing Heart in Primary Care The Failing Heart in Primary Care Hamid Ikram How fares the Heart Failure Epidemic? 4357 patients, 57% women, mean age 74 years HFSA 2010 Practice Guideline (3.1) Heart Failure Prevention A careful and

More information

Egyptian Hypertension Guidelines

Egyptian 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

State of the art treatment of hypertension: established and new drugs. Prof. M. Burnier Service of Nephrology and Hypertension Lausanne, Switzerland

State of the art treatment of hypertension: established and new drugs. Prof. M. Burnier Service of Nephrology and Hypertension Lausanne, Switzerland State of the art treatment of hypertension: established and new drugs Prof. M. Burnier Service of Nephrology and Hypertension Lausanne, Switzerland First line therapies in hypertension ACE inhibitors AT

More information

None. Disclosure: Relationships with Industry Conflicts of Interests. Learning Objectives: Participants will be able to:

None. 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 information

Update on Current Trends in Hypertension Management

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

More information

Management of Hypertension in Women

Management of Hypertension in Women Management of Hypertension in Women Eliseo J. Pérez-Stable MD Professor of Medicine DGIM, Department of Medicine July 1, 2013 Declaration of full disclosure: No conflict of interest (I have never been

More information

Hypertension: 2016 Clinical Update

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

More information