Pediatric Hypertension. Alisa A. Acosta, MD, MPH Asst. Professor, Renal Section April 5, 2019
|
|
- Jack Underwood
- 5 years ago
- Views:
Transcription
1 Pediatric Hypertension Alisa A. Acosta, MD, MPH Asst. Professor, Renal Section April 5, 2019
2 Objectives Recognize the importance of accurate blood pressure measurement in pediatric patients Define pediatric hypertension (HTN) according to the 2017 AAP Clinical Practice Guidelines Evaluate a pediatric patient with HTN Manage basic pediatric HTN Page 1 xxx00.#####.ppt 4/3/19 10:21:07 AM
3 Page 2 xxx00.#####.ppt 4/3/19 10:21:08 AM
4 Adult Data Absolute Risk for Ischemic Heart Disease Mortality Systolic BP (Graph looks similar for stroke risk) Lancet 2002; 360: Page 3 xxx00.#####.ppt 4/3/19 10:21:09 AM
5 HTN in Adults Almost one in three adults has HTN (32.6%) - Almost half don t know it (17.2%) - Almost 46% are under-treated Mozaffarian D et al, Circulation 2016;133: Lowering BP in adults with Stage 1 HTN leads to a reduction in the incidence of: - Myocardial infarctions (20-25%) - Stroke (35-40%) - Heart Failure (>50%) - AND overall mortality (~10% at 10 years) Chobanian, Hypertension 2003;42: Page 4 xxx00.#####.ppt 4/3/19 10:21:09 AM
6 Pediatric Hypertension Generally healthy children with primary HTN do not suffer from CV end points seen in adults Children with elevated BP are likely to become adults with hypertension Prevention, early detection, and appropriate treatment for those at risk is the way to eliminate the burden of this disease Page 5 xxx00.#####.ppt 4/3/19 10:21:10 AM
7 History of Hypertension in Pediatrics Before 1977: no accepted normative data 1977: 1 st Task Force Report (3 sources) - Normative data for children - Defined HTN >95 th percentile for age & gender 1987: 2 nd Task Force Report (9 sources) - Additional data for over 60,000 children - Improved racial mix 1996: Task Force Update - Incorporated height in the BP norms 2004: Fourth Working Group Report 2017: AAP Clinical Practice Guidelines (CPG) Page 6 xxx00.#####.ppt 4/3/19 10:21:11 AM
8 Page 7 xxx00.#####.ppt 4/3/19 10:21:11 AM
9 Table 1 Summary of KAS for Screening and Management of High BP in Children and Adolescents Page 8 xxx00.#####.ppt 4/3/19 10:21:12 AM
10 Table 11 Patient Evaluation & Management According to BP Level Page 9 xxx00.#####.ppt 4/3/19 10:21:13 AM
11 Classification of BP Children Page 10 xxx00.#####.ppt 4/3/19 10:21:14 AM
12 Epidemiologic Definition z = % 5% Page 11 xxx00.#####.ppt 4/3/19 10:21:15 AM
13 Who should have BP measured Children 3 years old should have BP measured annually Children 3 yrs at every health care encounter if meds/conditions increase risk for HTN Children < 3 years should have BP measured under special circumstances Page 12 xxx00.#####.ppt 4/3/19 10:21:16 AM
14 Special Circumstances for Children < 3 years old - Prematurity <32 wks or SGA, VLBW, other - Congenital heart disease - Renal disease or urologic malformation Recurrent UTI, hematuria, proteinuria FH of congenital renal disease - Solid-organ transplant - Malignancy or BMT - Tx with meds known to raise BP - Other systemic illnesses a/w HTN (NF, TS) - Evidence of elevated intracranial pressure Page 13 xxx00.#####.ppt 4/3/19 10:21:17 AM
15 Page 14 xxx00.#####.ppt 4/3/19 10:21:17 AM
16 Four Clinical Questions 1. Does my patient have hypertension? 2. Why does my patient have hypertension? 3. Is there any evidence of target organ damage? 4. Are there any other modifiable risk factors for CVD? Page 15 xxx00.#####.ppt 4/3/19 10:21:18 AM
17 Case 1 A 7 year old boy comes to your office for a well child check. Ht is 25 th % and wt is >95 th %. In triage using a machine and a child cuff, his blood pressure measures 117/78. His history and exam are normal. Does he have an elevated blood pressure? Page 16 xxx00.#####.ppt 4/3/19 10:21:19 AM
18 50 th %ile - 94/56 90 th %ile - 107/68 95 th %ile - 110/71 95 th /83 Pt s BP: 117/78 Page 17 xxx00.#####.ppt 4/3/19 10:21:19 AM
19 Dilemma of BP Measurement Norms based on auscultatory measurements with mercury manometers Oscillometric monitors are largely used - Poor correlation with auscultatory methods - Measure the MAP, calculates SBP & DBP using proprietary, unpublished algorithms BP > 90 th percentile by oscillometric devices should be repeated by auscultation Page 18 xxx00.#####.ppt 4/3/19 10:21:21 AM
20 BP Measurement Properly positioned -Seated -Back Supported -Feet on the floor -Arm resting at heart level After 5 mins of rest Empty bladder Avoidance of stimulant drugs or foods 30 mins prior Page 19 xxx00.#####.ppt 4/3/19 10:21:21 AM
21 Proper Cuff Size Small cuffs overestimate BP more than large cuffs under-estimate BP Between sizes, choose the larger cuff Page 20 xxx00.#####.ppt 4/3/19 10:21:22 AM
22 Case 1 You re-measure the blood pressure by auscultation after at least 5 minutes of rest. You measure the arm circumference to be 32 cm. Child cuff cm Adult cuff cm Page 21 xxx00.#####.ppt 4/3/19 10:21:23 AM
23 After changing to an adult cuff, his blood pressure was recorded as 105/67 50 th %ile - 94/56 90 th %ile - 107/68 95 th %ile - 110/71 95 th /83 Pt s Original BP: 117/78 Page 22 xxx00.#####.ppt 4/3/19 10:21:23 AM
24 Does this patient have hypertension? no Page 23 xxx00.#####.ppt 4/3/19 10:21:25 AM
25 Case 2 A 14 yr old boy has multiple visits with an elevated blood pressure ranging from the 130s- 143/ 70s-90 measured by auscultation with an appropriate sized cuff Height and weight =95 th percentile Remainder of his history and physical exam is benign, and there is no family history of hypertension Page 24 xxx00.#####.ppt 4/3/19 10:21:25 AM
26 Does this patient have hypertension? Patient s BP = 130s-143/ 70s-90s Page 25 xxx00.#####.ppt 4/3/19 10:21:26 AM
27 Is clinic BP the best measure? 24 hr Ambulatory Blood Pressure Monitoring Useful in the evaluation of - White coat hypertension - Apparent drug resistant hypertension - Evaluation of drug-induced hypotension Provides an overall BP pattern - BP load - Nocturnal BP Page 26 xxx00.#####.ppt 4/3/19 10:21:27 AM
28 24 hr Ambulatory BP Monitoring White-Coat Hypertension - Clinic BP is high but ambulatory BP (ABP) is normal - Prevalence in children is up to 62%, probably 20% - Pre-hypertensive state? Masked Hypertension - Clinic BP is normal but the ABP is elevated - Occurs in ~10% of youth - Same risk for CVD as those with sustained HTN Page 27 xxx00.#####.ppt 4/3/19 10:21:27 AM
29 Case 2: 24 hr ABPM Systolic BP Mean Arterial Pressure Diastolic BP Page 28 xxx00.#####.ppt 4/3/19 10:21:28 AM
30 130 mmhg 77 mmhg 95 th %ile Page 29 xxx00.#####.ppt 4/3/19 10:21:29 AM
31 Does this patient have hypertension? technically, no white coat HTN Page 30 xxx00.#####.ppt 4/3/19 10:21:29 AM
32 Case 3 An 8 yr old boy had an elevated mean BP by auscultation with an appropriate sized cuff on 3 separate occasions: 148/78, 154/90, 142/81 Asymptomatic, no significant PMH. MGM has HTN Wt 34.5kg (75%), Ht 131.5cm (25%), BMI 20.6 (90%) BP in RLE 103/72 Exam is benign but difficult to palpate LE pulses Page 31 xxx00.#####.ppt 4/3/19 10:21:30 AM
33 Case 3 Does this patient have hypertension? 148/78, 154/90, 142/81 Yes, Stage II 90 th %ile 110/72 95 th %ile 114/77 99 th %ile 122/85 Why does he have hypertension? Page 32 xxx00.#####.ppt 4/3/19 10:21:31 AM
34 Evaluation for Secondary HTN Secondary hypertension is more common in children The younger the child and /or the more severe the hypertension, the more likely there is a secondary cause Page 33 xxx00.#####.ppt 4/3/19 10:21:31 AM
35 Causes of Hypertension Renal parenchymal disease - Congenital anomalies of the urinary tract - Glomerulonephritis - Polycystic kidney disease - Sequelae of acute kidney injury, i.e. HUS - Chronic kidney disease - Systemic vasculitis with renal involvement Renovascular defect - Fibromuscular dysplasia - Midaortic syndrome - Renal vein thrombosis Page 34 xxx00.#####.ppt 4/3/19 10:21:32 AM
36 Causes of Hypertension Coarctation of the aorta Pulmonary - Chronic lung disease of the newborn Monogenic forms - AME - Liddle s syndrome - Gordon s syndrome - GRA Renal Tumors Endocrine - Catecholamine excess Pheochromocytoma Paraganglioma Neuroblastoma - Cushing syndrome - Hyperaldosteronism - Thyroid disorders - Congenital adrenal hyperplasia - Hypercalcemia Page 35 xxx00.#####.ppt 4/3/19 10:21:32 AM
37 Initial Evaluation Page 36 xxx00.#####.ppt 4/3/19 10:21:33 AM
38 Initial Evaluation Thorough history and physical exam Electrolytes, BUN, creatinine CBC +/- Thyroid function studies Urinalysis +/- urine cx Renal ultrasound - Scars - Congenital anomaly - Discordant kidney size Page 37 xxx00.#####.ppt 4/3/19 10:21:34 AM
39 Further Evaluation Renovascular imaging Plasma renin Plasma and urine steroid levels Plasma and urine catecholamines Page 38 xxx00.#####.ppt 4/3/19 10:21:35 AM
40 Case 3 Normal renal ultrasound Normal urinalysis Normal electrolytes, BUN, Cr Normal thyroid function tests Echocardiogram - Functional bicuspid aortic valve - Distal aortic arch appeared narrowed - Abdominal Doppler suggested mild obstruction - Mild concentric left ventricular hypertrophy Page 39 xxx00.#####.ppt 4/3/19 10:21:36 AM
41 Four Clinical Questions 1. Does my patient have hypertension? Yes 2. Why does my patient have hypertension? Coarctation of the aorta Page 40 xxx00.#####.ppt 4/3/19 10:21:37 AM
42 Case 4 11 yr old female, elevated BP by auscultation on multiple occasions, /78-89, confirmed by ABPM She is asymptomatic. Mom and maternal grandparents have hypertension. Negative PMH Wt 91.4kg (>97%), Ht 160.9cm (>97%), BMI 35.3kg/m 2 (>95%) Exam is unremarkable including 4 extremity BP Page 41 xxx00.#####.ppt 4/3/19 10:21:37 AM
43 Four Clinical Questions 1. Does my patient have hypertension? / th %ile 120/77 Yes, stage I 95 th %ile 124/81 99 th %ile 131/89 2. Why does she have hypertension? Page 42 xxx00.#####.ppt 4/3/19 10:21:38 AM
44 Case 4 Normal urinalysis Normal electrolytes, BUN, Cr Normal thyroid function tests Normal renal ultrasound (not indicated) Page 43 xxx00.#####.ppt 4/3/19 10:21:38 AM
45 Four Clinical Questions 1. Does my patient have hypertension? Yes 2. Why does my patient have hypertension? Primary hypertension, likely obesity-related, family history, etc. Page 44 xxx00.#####.ppt 4/3/19 10:21:39 AM
46 The Obesity Epidemic Page 45 xxx00.#####.ppt 4/3/19 10:21:40 AM
47 Prevalence of Obesity* Among US Children and Adolescents (aged 2 19 years) 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% NHANES II NHANES III NHANES NHANES *age and sex-specific BMI 95 th percentile Ages 2-5 Ages 6-11 Ages Page 46 xxx00.#####.ppt 4/3/19 10:21:41 AM
48 Hypertension follows Obesity Distribution of BMI percentiles and the prevalence of HTN within each BMI percentile category Sorof et al, J Pediatr 2002;140:660-6 Page 47 xxx00.#####.ppt 4/3/19 10:21:41 AM
49 Four Clinical Questions 1. Does my patient have hypertension? Yes 2. Why does my patient have hypertension? Likely obesity-related, family history 3. Is there any evidence of target organ damage? Page 48 xxx00.#####.ppt 4/3/19 10:21:43 AM
50 Target Organ Damage Measurable abnormalities attributed to HTN that occur before significant cardiovascular events -Microalbuminuria or overt proteinuria -Hypertensive retinopathy -Left ventricular hypertrophy -Increased carotid artery intima media thickness -Decreased vascular compliance Page 49 xxx00.#####.ppt 4/3/19 10:21:43 AM
51 Left Ventricular Hypertrophy Most prominent evidence of target organ damage - Echocardiography should be performed at the time of consideration of pharmacologic therapy - Monitored every 6-12 months Page 50 xxx00.#####.ppt 4/3/19 10:21:44 AM
52 Four Clinical Questions 1. Does my patient have hypertension? Yes 2. Why does my patient have hypertension? Likely obesity-related, family history 3. Is there any evidence of target organ damage? Yes, LVH on echocardiogram 4. Are there any other modifiable risk factors for CVD? Page 51 xxx00.#####.ppt 4/3/19 10:21:45 AM
53 Evaluation for Co-morbidities Fasting labs -Lipid panel -Hgb A1c -AST, ALT If indicated: -Drug Screen -TSH -CBC -Polysomnography Snoring or other symptoms of sleep disorded breathing Nocturnal hypertension Page 52 xxx00.#####.ppt 4/3/19 10:21:45 AM
54 Case 4 Fasting labs - Normal lipid panel - Normal Hgb A1c Sleep Study - Obstructive sleep apnea - Treated with CPAP Page 53 xxx00.#####.ppt 4/3/19 10:21:46 AM
55 Four Clinical Questions 1. Does my patient have hypertension? Yes 2. Why does my patient have hypertension? Likely obesity-related, family history 3. Is there any evidence of target organ damage? Yes, LVH on echocardiogram 4. Are there any other modifiable risk factors for CVD? Several: wt management, insulin resistance, sleep apnea Page 54 xxx00.#####.ppt 4/3/19 10:21:47 AM
56 Now what? How should I treat my patient s hypertension?
57 Meds or no meds? Therapeutic lifestyle changes initiated in all patients - Healthy eating - Regular cardiovascular exercise - Good sleeping habits Family-based intervention improves success Avoid stimulant medications when possible Page 56 xxx00.#####.ppt 4/3/19 10:21:48 AM
58 Weight Loss Indicated in obesity-related HTN Weight loss improves - BP in overweight adolescents - Salt sensitivity of BP - Decreases other cardiovascular risk factors Dyslipidemia Insulin resistance Page 57 xxx00.#####.ppt 4/3/19 10:21:49 AM
59 Page 58 xxx00.#####.ppt 4/3/19 10:21:49 AM
60 Sodium Restriction Increased sodium intake is associated with higher BP at all ages Current Recommendations year olds 1.2 g/day - > 8 years 1.5 g/day Page 59 xxx00.#####.ppt 4/3/19 10:21:50 AM
61 Page 60 xxx00.#####.ppt 4/3/19 10:21:51 AM
62 Physical Activity Regular physical activity is beneficial for preventing and treating HTN in adults In children - Inverse relationship between fitness and SBP - Improved fitness slows the progression of elevated BP at one year - Studies suggest an effect of exercise on BP reduction independent of weight loss Page 61 xxx00.#####.ppt 4/3/19 10:21:51 AM
63 Indications for Pharmacotherapy Symptomatic hypertension Secondary hypertension Stage 2 hypertension Target organ damage Diabetes (types 1 and 2), CKD Persistent hypertension despite nonpharmacologic measures Page 62 xxx00.#####.ppt 4/3/19 10:21:52 AM
64 Pharmacotherapy Clinical trials have expanded the number of drugs with pediatric dosing Pharmacotherapy should be initiated with a single drug Goal is a reduction of BP to <95th percentile - Goal of <90th percentile if concurrent conditions are present Page 63 xxx00.#####.ppt 4/3/19 10:21:53 AM
65 Pharmacotherapy ACE inhibitor Angiotensin-receptor blocker Benazepril, Captopril, Enalapril, Fosinopril, Lisinopril, Quinapril Irbesartan, Losartan, Valsaratan, Telmisartan α- and β-antagonist Labetalol β-antagonist Calcium channel blocker Central α- agonist Diuretic Peripheral α- antagonist Vasodilator Atenolol, Bisoprolol/HCTZ, Metoprolol, Propranolol Amlodipine, Felodipine, Isradipine Extended-release nifedipine Clonidine Furosemide, HCTZ, Amiloride Spironolactone, Triamterene Chlorthalidone Doxazosin, Prazosin, Terazosin Hydralazine, Minoxidil
66 Choosing a Medication Based on benefit/side effect profile, availability, and ease of administration No evidence HCTZ should be first line agent Racial differences in response to various drug classes have yet to be shown Maximize the dose of single agent before adding additional agents Page 65 xxx00.#####.ppt 4/3/19 10:21:53 AM
67 Choosing a Medication Calcium channel blockers are generally safe first line agents while awaiting evaluation Beta blockers - Avoid the use in asthma patients - Preferred drug if history of migraine HA Avoid ACEi and ARB until renal evaluation is complete Page 66 xxx00.#####.ppt 4/3/19 10:21:54 AM
68 Page 67 xxx00.#####.ppt 4/3/19 10:21:55 AM
Dr Doris M. W Kinuthia
Dr Doris M. W Kinuthia Objectives Normal blood pressures in children Measurement of blood pressure in children Aetiology of Hypertension in children Evaluation of children with hypertension Treatment of
More informationManagement of Hypertension
Clinical Practice Guidelines Management of Hypertension Definition and classification of blood pressure levels (mmhg) Category Systolic Diastolic Normal
More informationHypertensionTreatment Guidelines. Michaelene Urban APRN, MSN, ACNS-BC, ANP-BC
HypertensionTreatment Guidelines Michaelene Urban APRN, MSN, ACNS-BC, ANP-BC Objectives: Review the definition of the different stages of HTN. Review the current guidelines for treatment of HTN. Provided
More informationApproach to patient with hypertension. Dr. Amitesh Aggarwal
Approach to patient with hypertension Dr. Amitesh Aggarwal Definition A systolic blood pressure ( SBP) >139 mmhg and/or A diastolic (DBP) >89 mmhg. Based on the average of two or more properly measured,
More informationHypertension (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
More informationJared Moore, MD, FACP
Hypertension 101 Jared Moore, MD, FACP Assistant Program Director, Internal Medicine Residency Clinical Assistant Professor of Internal Medicine Division of General Medicine The Ohio State University Wexner
More informationHypertension Epidemiology 6% of deaths worldwide Defined as any of the following: systolic blood pressure 140 mmhg, diastolic blood pressure 90 mmhg, taking antihypertensive medications Pulse pressure=
More informationPharmacologic Management of Hypertension
Current Concepts In Management of Fernando Vega, MD Secondary - Definition Renovascular Disease (The kidney doesn t get impressed by blood pressure) Renovascular stenosis Renal artery stenosis Fibromuscular
More information7/7/ 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
More informationCategories of HTN. Overview of Hypertension. Types of Hypertension
Categories of HTN Overview of Hypertension Normal SBP 100 Quick review of the Basics: What is
More informationADVANCES IN MANAGEMENT OF HYPERTENSION
Advances in Management of Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Current Status of Prevalence 29%; Blacks 33.5%
More informationSecondary hypertension How to approach?
Secondary hypertension How to approach? Tomáš Seeman Department of Pediatrics and Transplantation Center, University Hospital Motol, 2 nd Faculty of Medicine, Charles University Prague, Czech Republic
More informationhypertension Head of prevention and control of CVD disease office Ministry of heath
hypertension t. Samavat MD,Cadiologist,MPH Head of prevention and control of CVD disease office Ministry of heath RECOMMENDATIONS FOR HYPERTENSION DIAGNOSIS, ASSESSMENT, AND TREATMENT Definition of hypertension
More informationTreating Hypertension from
Treating Hypertension from Initiation to Resistance: A Case Study Approach Michelle Krause, MD Division of Nephrology University of Arkansas for Medical Sciences Central Arkansas Veteran s Healthcare System
More informationDifficult-to-Control & Resistant Hypertension. Anthony Viera, MD, MPH, FAHA Professor and Chair
Difficult-to-Control & Resistant Hypertension Anthony Viera, MD, MPH, FAHA Professor and Chair Objectives Define resistant hypertension Discuss evaluation strategy for patient with HTN that appears difficult
More informationHypertension Update Background
Hypertension Update Background Overview Aaron J. Friedberg, MD Assistant Professor, Clinical Division of General Internal Medicine The Ohio State University Wexner Medical Center Management Guideline Comparison
More informationADVANCES IN MANAGEMENT OF HYPERTENSION
Prevalence 29%; Blacks 33.5% About 72.5% treated; 53.5% uncontrolled (>140/90) Risk for poor control: Latinos, Blacks, age 18-44 and 80,
More informationHypertension. 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,
More informationHypertension Update. Aaron J. Friedberg, MD
Hypertension Update Aaron J. Friedberg, MD Assistant Professor, Clinical Division of General Internal Medicine The Ohio State University Wexner Medical Center Background Diagnosis Management Overview Guideline
More informationModern Management of Hypertension
Modern Management of Hypertension Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Current Status of Hypertension Prevalence
More informationRESISTENT HYPERTENSION. Dr. Helmy Bakr Professor and Head of Cardiology Dept. Mansoura University
RESISTENT HYPERTENSION Dr. Helmy Bakr Professor and Head of Cardiology Dept. Mansoura University Resistant Hypertension Blood pressure remaining above goal in spite of concurrent use of 3 antihypertensive
More informationMODERN 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
More informationHypertension CHAPTER-I CARDIOVASCULAR SYSTEM. Dr. K T NAIK Pharm.D Associate Professor Department of Pharm.D Krishna Teja Pharmacy College, Tirupati
CHAPTER-I CARDIOVASCULAR SYSTEM Hypertension SUB: PHARMACOTHERAPEUTICS-I CODE:T0820006 Dr. K T NAIK Pharm.D Associate Professor Department of Pharm.D Krishna Teja Pharmacy College, Tirupati Hypertension
More informationDiabetes and Hypertension
Diabetes and Hypertension M.Nakhjvani,M.D Tehran University of Medical Sciences 20-8-96 Hypertension Common DM comorbidity Prevalence depends on diabetes type, age, BMI, ethnicity Major risk factor for
More informationHypertension Pharmacotherapy: A Practical Approach
Hypertension Pharmacotherapy: A Practical Approach Ronald Victor, MD Burns & Allen Chair in Cardiology Director, The Hypertension Center Associate Director, The Heart Institute Hypertension Center 1. 2.
More informationVA/DoD Clinical Practice Guideline for the Diagnosis and Management of Hypertension - Pocket Guide Update 2004 Revision July 2005
VA/DoD Clinical Practice Guideline for the Diagnosis and Management of Hypertension - Pocket Guide Update 2004 Revision July 2005 1 Any adult in the health care system 2 Obtain blood pressure (BP) (Reliable,
More informationHypertension and the 2017 Guidelines Meeting the Targets in Small Groups. Lisa Ivy APRN
Hypertension and the 2017 Guidelines Meeting the Targets in Small Groups Lisa Ivy APRN The 2017 Guideline is an Update to JNC7 New information regarding BP related risk of CVD Ambulatory BP monitoring
More informationHypertension Update. Sarah J. Payne, MS, PharmD, BCPS Assistant Professor, Department of Pharmacotherapy UNT System College of Pharmacy
Hypertension Update Sarah J. Payne, MS, PharmD, BCPS Assistant Professor, Department of Pharmacotherapy UNT System College of Pharmacy Introduction 1/3 of US adults have HTN More prevalent in non-hispanic
More informationINTRODUCTION TO RENAL SYSTYEM IN PEDIATRICS
INTRODUCTION TO RENAL SYSTYEM IN PEDIATRICS ANATOMY & PHYSIOLOGY OF KIDNEY Same as that of an adult but with few differences ; 1. Length approx. 6 cm and weight 24gm in a full term newborn as compared
More informationModern Management of Hypertension: Where Do We Draw the Line?
Modern Management of Hypertension: Where Do We Draw the Line? Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Blood Pressure
More informationΑΡΥΙΚΗ ΠΡΟΔΓΓΙΗ ΤΠΔΡΣΑΙΚΟΤ ΑΘΔΝΟΤ. Μ.Β.Παπαβαζιλείοσ Καρδιολόγος FESC - Γιεσθύνηρια ιζμανόγλειον ΓΝΑ Clinical Hypertension Specialist ESH
ΑΡΥΙΚΗ ΠΡΟΔΓΓΙΗ ΤΠΔΡΣΑΙΚΟΤ ΑΘΔΝΟΤ Μ.Β.Παπαβαζιλείοσ Καρδιολόγος FESC - Γιεσθύνηρια ιζμανόγλειον ΓΝΑ Clinical Hypertension Specialist ESH Hypertension Co-Morbidities HTN Commonly Clusters with Other Risk
More informationPreventing and Treating High Blood Pressure
Preventing and Treating High Blood Pressure: Finding the Right Balance of Integrative and Pharmacologic Approaches Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Blood Pressure
More informationChronic Pediatric Hypertension
Chronic Pediatric Hypertension Nephrology Grand Round 3/13/2015 Mahmoud Kallash M.D Outline Definition of hypertension (HTN) Challenges in diagnosing HTN Epidemiology Causes and evaluation of HTN Management
More informationIntroductory Clinical Pharmacology Chapter 41 Antihypertensive Drugs
Introductory Clinical Pharmacology Chapter 41 Antihypertensive Drugs Blood Pressure Normal = sys
More informationDifficult to Treat Hypertension
Difficult to Treat Hypertension According to Goldilocks JNC 8 Blood Pressure Goals (2014) BP Goal 60 years old and greater*- systolic < 150 and diastolic < 90. (Grade A)** BP Goal 18-59 years old* diastolic
More informationHypertension Update Warwick Jaffe Interventional Cardiologist Ascot Hospital
Hypertension Update 2008 Warwick Jaffe Interventional Cardiologist Ascot Hospital Definition of Hypertension Continuous variable At some point the risk becomes high enough to justify treatment Treatment
More informationHypertension in Paediatric Haematology/Oncology
in Paediatric Haematology/Oncology Overview and aetiology: is a common problem in Paediatric Haematology and Oncology patients. There are a number of causes, some related to the disease itself or the treatment,
More informationYounger adults with a family history of premature artherosclerotic disease should have their cardiovascular risk factors measured.
Appendix 2A - Guidance on Management of Hypertension Measurement of blood pressure All adults from 40 years should have blood pressure measured as part of opportunistic cardiovascular risk assessment.
More informationManaging Hypertension in 2016
Managing Hypertension in 2016: Where Do We Draw the Line? Disclosure No relevant financial relationships Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine baron@medicine.ucsf.edu
More informationHypertension. Risk of cardiovascular disease beginning at 115/75 mmhg doubles with every 20/10mm Hg increase. (Grade B)
Practice Guidelines and Principles: Guidelines and principles are intended to be flexible. They serve as reference points or recommendations, not rigid criteria. Guidelines and principles should be followed
More informationTake The Stress Out of Pediatric Hypertension! Rasheda Amin, MD Division of Nephrology Pediatric Specialists of Virginia George Washington University
Take The Stress Out of Pediatric Hypertension! Rasheda Amin, MD Division of Nephrology Pediatric Specialists of Virginia George Washington University Disclosure I have no financial interests or relationships
More informationDr Narender Goel MD (Internal Medicine and Nephrology) Financial Disclosure: None, Conflict of Interest: None
Dr Narender Goel MD (Internal Medicine and Nephrology) drnarendergoel@gmail.com Financial Disclosure: None, Conflict of Interest: None 12 th December 2013, New York Visit us at: http://kidneyscience.info/
More informationCreative blood pressure management: whys and the tricks
Creative blood pressure management: whys and the tricks Cynthia D. Caraballo-Hunt, MD Kaiser/OHSU Family Medicine Faculty Beaverton Medical Office NW Permanente, Portland, OR Objectives 1. Describe current
More informationHypertension Management Controversies in the Elderly Patient
Hypertension Management Controversies in the Elderly Patient Juan Bowen, MD Geriatric Update for the Primary Care Provider November 17, 2016 2016 MFMER slide-1 Disclosure No financial relationships No
More informationTIP. Documentation and coding guide. Disease definitions* Prevalence and statistics associated with HTN**
Documentation and coding guide Disease definitions* HTN is diagnosed when the average of two or more (systolic of diastolic) blood pressure readings are found to be elevated on two or more office visits
More informationGetting BP to goal: Virginia L. Hood MB.BS, MPH, FACP
Getting BP to goal: Virginia L. Hood MB.BS, MPH, FACP Objectives: Outline pathophysiological processes that sustain high BP Design individual treatment strategies for BP not at goal Facilitate patient
More informationNew Hypertension Guideline Recommendations for Adults July 7, :45-9:30am
Advances in Cardiovascular Disease 30 th Annual Convention and Reunion UERM-CMAA, Inc. Annual Convention and Scientific Meeting July 5-8, 2018 New Hypertension Guideline Recommendations for Adults July
More informationManagement of Hypertension. M Misra MD MRCP (UK) Division of Nephrology University of Missouri School of Medicine
Management of Hypertension M Misra MD MRCP (UK) Division of Nephrology University of Missouri School of Medicine Disturbing Trends in Hypertension HTN awareness, treatment and control rates are decreasing
More informationImportance of Ambulatory Blood Pressure Monitoring in Adolescents
Importance of Ambulatory Blood Pressure Monitoring in Adolescents Josep Redon, MD, PhD, FAHA Internal Medicine Hospital Clinico Universitario de Valencia University of Valencia CIBERObn Instituto de Salud
More information2014 HYPERTENSION GUIDELINES
2014 HYPERTENSION GUIDELINES Eileen M. Twomey, Pharm.D., BCPS 1 Learning Objectives Describe specific blood pressure thresholds at which antihypertensive therapy should be initiated and blood pressure
More informationBy 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
More informationWhat s In the New Hypertension Guidelines?
American College of Physicians Ohio/Air Force Chapters 2018 Scientific Meeting Columbus, OH October 5, 2018 What s In the New Hypertension Guidelines? Max C. Reif, MD, FACP Objectives: At the end of the
More informationEgyptian Hypertension Guidelines
Egyptian Hypertension Guidelines 2014 Egyptian Hypertension Guidelines Dalia R. ElRemissy, MD Lecturer of Cardiovascular Medicine Cairo University Why Egyptian Guidelines? Guidelines developed for rich
More informationManagement of High Blood Pressure in Children and Adolescents
Π.Μ.Σ. «ΜΟΝΑΔΕΣ ΕΝΤΑΤΙΚΗΣ ΘΕΡΑΠΕΙΑΣ - ΚΑΡΔΙΟΛΟΓΙΚΗ ΝΟΣΗΛΕΥΤΙΚΗ» Management of High Blood Pressure in Children and Adolescents ΕΠΙΔΡΑΣΗ ΤΗΣ ΑΝΤΙΥΠΕΡΤΑΣΙΚΗΣ ΑΓΩΓΗΣ ΣΤΗΝ ΑΡΤΗΡΙΑΚΗ ΣΚΛΗΡΙΑ ΥΠΕΡΤΑΣΙΚΩΝ ΑΣΘΕΝΩΝ
More informationMANAGEMENT OF HYPERTENSION: TREATMENT THRESHOLDS AND MEDICATION SELECTION
Management of Hypertension: Treatment Thresholds and Medication Selection Robert B. Baron, MD MS Professor and Associate Dean Declaration of full disclosure: No conflict of interest Presentation Goals
More informationCOMPLEX HYPERTENSION. Anita Ralstin, FNP-BC Next Step Health Consultant, LLC
COMPLEX HYPERTENSION Anita Ralstin, FNP-BC Next Step Health Consultant, LLC Incidence Of Hypertension About 70 million American adults have high blood pressure. About 33% of the population Only 52% have
More informationUpdate in Hypertension
Update in Hypertension Eliseo J. PérezP rez-stable MD Professor of Medicine DGIM, Department of Medicine UCSF 20 May 2008 Declaration of full disclosure: No conflict of interest (I have never been funded
More informationHypertension 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 informationBlood Pressure Treatment in 2018
Blood Pressure Treatment in 2018 Jay D. Geoghagan, MD, FACC Disclosures: None 1 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/ APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management
More informationThe 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 informationTodd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM
Todd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM Faculty Disclosure I have no financial interest to disclose No off-label use of medications will be discussed FIFTH ANNUAL SYMPOSIUM Recognize changes between
More informationAntihypertensive Agents Part-2. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia
Antihypertensive Agents Part-2 Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Agents that block production or action of angiotensin Angiotensin-converting
More informationCONCORD INTERNAL MEDICINE HYPERTENSION PROTOCOL
CONCORD INTERNAL MEDICINE HYPERTENSION PROTOCOL Douglas G. Kelling Jr., MD Carmella Gismondi-Eagan, MD, FACP George C. Monroe, III, MD Revised, April 8, 2012 The information contained in this protocol
More informationHypertension Cases. Katharine Dahl, MD January 10, 2017
Hypertension Cases Katharine Dahl, MD January 10, 2017 Dr. Dahl arrives late for her AHD hypertension lecture and you are asked to present the epidemiology of hypertension until she arrives. Which of the
More informationAdult Blood Pressure Clinician Guide June 2018
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Adult Blood Pressure Clinician Guide June 2018 Adult Blood Pressure Clinician Guide June 2018 Introduction This Clinician Guide is based on the 2018
More informationObjectives. JNC 7 Is Nice But What s Up With JNC 8? Why Do We Care? Hypertension Background: Prevalence
JNC 7 Is Nice But What s Up With JNC 8? 37 th Annual CAPA Conference October 4 th 2013 Ignacio de Artola, Jr. M.D. Assistant Professor of Clinical Family Medicine Medical Director, Primary Care Physician
More informationHypertension with Comorbidities Treatment of Metabolic Risk Factors in Children and Adolescents
Hypertension with Comorbidities Treatment of Metabolic Risk Factors in Children and Adolescents Stella Stabouli Ass. Professor Pediatrics 1 st Department of Pediatrics Hippocratio Hospital Evaluation of
More informationWhat in the World is Functional Medicine?
What in the World is Functional Medicine? An Introduction to a Systems Based Approach of Chronic Disease Meneah R Haworth, FNP-C Disclosure v I am a student of the Institute for Functional Medicine. They
More informationA CASE OF HYPERTENSION AND ACUTE RENAL FAILURE OBJECTIVES
A CASE OF HYPERTENSION AND ACUTE RENAL FAILURE Maricel Pilapil-Pureza WLA Nephrology OBJECTIVES After the presentation, the attendee will be able to: 1. Discuss when to suspect for secondary causes of
More informationCardiac Pathophysiology
Cardiac Pathophysiology Evaluation Components Medical history Physical examination Routine laboratory tests Optional tests Medical History Duration and classification of hypertension. Patient history of
More informationSecondary Hypertension: A Real World Approach
Secondary Hypertension: A Real World Approach Evan Brittain, MD December 7, 2012 Kingston, Jamaica Disclosures None Real World Causes Renovascular Hypertension Endocrine Obstructive Sleep Apnea Pseudosecondary
More informationNew Hypertension Guidelines. Kofi Osei, MD
New Hypertension Guidelines Kofi Osei, MD None Disclosures Objectives The new blood pressure definitions and cardiovascular risk The role to time and location in the diagnosis of hypertension Apply evidence-based
More informationPEDIATRIC HYPERTENSION CLINICAL PRACTICE GUIDELINES. Milena Archuleta, MSN, MBA, FNP-BC, CPHON University of New Mexico Hospital
PEDIATRIC HYPERTENSION CLINICAL PRACTICE GUIDELINES Milena Archuleta, MSN, MBA, FNP-BC, CPHON University of New Mexico Hospital None Disclosures Hypertension: Why so Important? Occurs in 3.5% of all pediatric
More information신장환자의혈압조절 나기영. Factors involved in the regulation of blood pressure
신장환자의혈압조절 K/DOQI Clinical practice guidelines on Hypertension and Antihypertensive agents in CKD 나기영 Factors involved in the regulation of blood pressure Renal function curve MAP (mmhg) Central role of
More informationIncidental Findings; Management of patients presenting with high BP. Phil Swales
Incidental Findings; Management of patients presenting with high BP Phil Swales Consultant Physician Acute & General Medicine University Hospitals of Leicester NHS Trust Objectives The approach to an incidental
More informationHYPERTENSION GUIDELINES WHERE ARE WE IN 2014
HYPERTENSION GUIDELINES WHERE ARE WE IN 2014 Donald J. DiPette MD FACP Special Assistant to the Provost for Health Affairs Distinguished Health Sciences Professor University of South Carolina University
More informationHTN talk_l Davis_ /28/2018
1 2 GUIDELINES PUBLISHED AHEAD OF PRINT NOV 13, 2017 = SAME DAY AS PUBLIC PRESENTATION LESLIE L DAVIS, PHD, RN, ANP-BC, FPCNA, FAANP, FAHA The New Guidelines Have Been Published! Whelton PK, Carey RM,
More informationHypertension in Pediatrics New Guidelines
Hypertension in Pediatrics New Guidelines MARISELIS ROSA-SAN CHEZ, M D PEDIATRIC NEPHROLOGY Disclosure Information In the past 12 months, I have had no relevant financial relationships with the manufacturer(s)
More informationSAURIN GANDHI, AZCOM Evidence-Based Guideline for the Management of High Blood Pressure in Adults (JNC 8)
2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults (JNC 8) Background HTN is the most common condition seen in primary care and leads to MI, stroke, renal failure, and death
More informationThe Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children
More informationCombination Therapy for Hypertension
Combination Therapy for Hypertension Se-Joong Rim, MD Cardiology Division, Yonsei University College of Medicine, Seoul, Korea Goals of Therapy Reduce CVD and renal morbidity and mortality. Treat to BP
More informationHypertension diagnosis (see detail document) Diabetic. Target less than 130/80mmHg
Hypertension diagnosis (see detail document) Non-diabetic Diabetic Very elderly (older than 80 years) Target less than 140/90mmHg Target less than 130/80mmHg Consider SBP target less than 150mmHg Non-diabetic
More informationSystemic Hypertension Dr ahmed almutairi Assistant professor Internal medicine dept
Systemic Hypertension Dr ahmed almutairi Assistant professor Internal medicine dept Continents 1- introduction 2- classification/definition 3- classification/etiology 4-etiology in both categories 5- complications
More informationHow Low Do We Go? Update on Hypertension
How Low Do We Go? Update on Beth L. Abramson, MD, FRCPC, FACC As presented at the University of Toronto s Saturday at the University Session (September 2003) Arecent World Health Organization report states
More informationCHALLENGES OF HYPERTENSION IN THE COALFACE
CHALLENGES OF HYPERTENSION IN THE COALFACE Y VERIAVA CENTRE FOR RURAL HEALTH SCHOOL OF CLINICAL MEDICINE FACULTY OF HEALTH SCIENCES UNIVERSITY OF WITWATERSRAND SYSTOLIC AND DIASTOLIC BLOOD PRESSURES (BP)
More informationAntihypertensive drugs: I. Thiazide and other diuretics:
Clinical assessment of hypertensive patient: You have to take history regarding the presence of other risk factors for CAb like diabetes mellitus, smoking, etc. Take history whether the patient takes medications
More informationMANAGEMENT OF HYPERTENSION IN PREGNANCY, THE ALGORHITHM
MANAGEMENT OF HYPERTENSION IN PREGNANCY, THE ALGORHITHM Are Particular Anti-hypertensives More Effective or Harmful Than Others in Hypertension in Pregnancy? Existing data is inadequate Methyldopa and
More informationRESISTANT HYPERTENSION
RESISTANT HYPERTENSION John D. Bisognano, MD PhD Professor of Medicine / Cardiology President-Elect, American Society of Hypertension Director, Outpatient Cardiology University of Rochester RESISTANT HYPERTENSION
More informationThe measurement of blood pressure and hypertension. Handout Fenyvesi Tamás III.Department of Medicine
The measurement of blood pressure and hypertension Handout Fenyvesi Tamás III.Department of Medicine 1 2 History of the blood pressure measurement direct Stephen HALES 1726 horse carotid indirect Riva-Rocci
More informationHypertension: JNC-7. Southern California University of Health Sciences Physician Assistant Program
Hypertension: JNC-7 Southern California University of Health Sciences Physician Assistant Program Management and Treatment of Hypertension April 17, 2018, presented by Ezra Levy, Pharm.D.! Reference Card
More informationHypertension Management - Summary
Who should have blood pressure assessed? Hypertension Management - Summary All patients over the age of 40 years, every 1-3 years in order to determine their cardiovascular risk (ie. Framingham Risk Score)
More informationHYPERTENSION: Sustained elevation of arterial blood pressure above normal o Systolic 140 mm Hg and/or o Diastolic 90 mm Hg
Lecture 39 Anti-Hypertensives B-Rod BLOOD PRESSURE: Systolic / Diastolic NORMAL: 120/80 Systolic = measure of pressure as heart is beating Diastolic = measure of pressure while heart is at rest between
More informationWhat s all the Fuss?
HYPERTENSION: What s all the Fuss? Presenter name: Presenter title: Department: Institute Marc A. Pohl, MD Ray W. Gifford Chair in Hypertension, and Head, Section of Clinical Hypertension Nephrology and
More informationHypertension 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
More informationChildren with Hypertension in ED
Children with Hypertension in ED By Prof. Sanaa AK Helmy Professor of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Cairo University Vice-chairman of the Egyptian Society of Emergency
More informationSpecial Lecture 11/08/2013. Hypertension Dr. HN Mayrovitz
Special Lecture 11/08/2013 Hypertension Dr. HN Mayrovitz Arterial Blood Pressure (ABP) Major Factors Summarized Sympathetic Hormones Arteriole MAP ~ Q x TPR + f (V / C) SV x HR Renal SBP Hypertension =
More information2017 AAP Guidelines for Childhood Hypertension
2017 AAP Guidelines for Childhood Hypertension Joseph T. Flynn, MD, MS, FAAP Professor of Pediatrics, University of Washington Chief, Division of Nephrology, Seattle Children s Hospital Disclaimer In the
More information