Falls Assessment and Medication

Size: px
Start display at page:

Download "Falls Assessment and Medication"

Transcription

1 Falls Assessment and Medication Professor T.Masud President-Elect British Geriatrics Society Nottingham University Hospitals NHS Trust, UK Visiting Professor University of Southern Denmark

2 Mrs GH is a 84 year old woman who is having recurrent falls MMSE 20/30 Vascular Parkinsonism CKD-3 AMD Hypertension DH: Bendroflumethiazide 2.5mg, Amlodipine 10mg BP lying 180/90 BP standing immediate 140/70 (slightly dizzy) BP standing 3 mins 175/90 Would you : 1. Reduce antihypertensives? 2. Increase antihypertensives? 3. Make no change?

3 Introduction Cardiovascular Risk Factors and falls Cardiovascular Medications and Falls Interventions to Reduce FRIDs

4 Occurrence - Annual incidence 65+ yrs : 28-35% - Campbell Prudham Blake yrs : 32-42% - Tinetti Downton 1991 Previous Fallers 60-70% - Nevitt 1989 Institutional care >50% - Tinetti 1989

5 IMPACT OF FALLS

6 CAUSES OF FALLS Falls are Often Multifactorial INTRINSIC FACTORS FALLS EXTRINSIC FACTORS Co-morbidity increases the risk of falls

7 Intrinsic (personal) Factors Causing Falls

8 Extrinsic (Environmental) Factors

9 MEDICATIONS & FALLS Polypharmacy (association of 5+ drugs and falls) Sedative-hypnotics, especially long acting benzodiazepines Antipsychotics Antidepressants Anticholinergic Burden Cardiovascular Drugs

10

11 Antidepresssants and Falls- the SOMA study Masud T, Frost M, Ryg J, Matzen L, Ibsen M, Abrahamsen B, Brixen K. Central nervous system medications and falls risk in men aged years: the Study on Male Osteoporosis and Aging (SOMA). Age Ageing 2013; 42: Antidepressants Overall Tricyclics SSRIS Fallers OR (95%CI)

12 Opiates and Falls - The SOMA study Opiates Overall Opiates 67 yrs Opiates < 67 yrs Fallers OR (95%CI)

13 Introduction Cardiovascular Risk Factors and falls Cardiovascular Medications and Falls Interventions to Reduce FRIDs

14 Cardiovascular Risk Factors for Falls Cerebral Hypoperfusion Orthostatic Hypotension Cardiac Dysrhythmias Structural Heart Disease (eg aortic stenosis) Reflex Syncope (eg vasovagal, carotid sinus syndrome) Autonomic failure Heart failure Hypovolaemia Cardiovascular Mediciations (Adapted from Thijs 2004)

15 Cardiovascular Risk Factors for Falls Other Mechanisms: Interacting Framework CV Disorders eg Arrhythmias Hypoperfusion (near) Syncope LV function (Orthostatic) Hypotension Carotid sinus Syndrome WML Stroke Cognition Depression Gait / Mobility FALL Interacting Risk factors eg (Adapted from S. Jansen PhD 2015) FRIDS Vision OA Urinary Urgency

16 Introduction Cardiovascular Risk Factors and falls Cardiovascular Medications and Falls Interventions to Reduce FRIDs

17 Cardiovascular Drugs and Falls CV Conditions Hypertension Ischaemic Heart Disease Arrhythmias Heart Failure CV Drugs Diuretics B-Blockers Alpha Adrenergic Blockers Ca Channel Blockers ACE Inhibitors Angiotensin II receptor Blockers Peripheral Vasodilators Anti-arrhythmics

18 Anti-hypertensives and Falls Antihypertensives were one of the major risk factors for falls in Geriatric rehabilitation settings (Vieira 2011 systematic Review) Diuretics and B Blockers associated with falls in hospitalised patients (Costa-Dias 2014, retrospective Portugese study) In individuals with recurrent falls at baseline: higher intensity anit-hypertensive treatment is associated with future serious falls (longitudinal studies, Callisaya 2014, Tinetti 2014)

19

20 Initiation of Hypertensives Current prescribing of thiazides is associated with an increased risk of falling and that this is strongest in the 3 weeks following the first prescription (Gribbin 2010, UK, case controlled, GPRD, n= 9682) The risk of falls on initiation of antihypertensive drugs in the elderly First 14 Days (Butt 2012, population based Canadian case controlled)

21 Anti-hypertensives and Falls Meta-analysis no clear relationship between antihypertensives and serious injurious falls (Zang 2013, 42 studies) ACEIs, ARBs, Ca Blockers may be protective against injurious falls (Kuschel 2014, case controlled Swedish study n=64000) ACEIs and ARBs protective against falls (Wong 2013, prospective Australian study n= 520)

22 Hypertension (HT), Orthostatic Hypotension (OH) and AntiHypertensives HYVET - survival benefits in treating HT in very elderly (Beckett 2008) Isolated Systolic HT associated with OH (Rutan 1992) Uncontrolled HT associated with OH (Kamaruzzaman 2010) Those with OH had higher SBP and DBP than those without OH Those with normal or controlled BP had lower prevalence of OH (PARTAGE study, n=994, > 80 years) OH and Falls were 2.5 fold in those with uncontrolled HT (>140/90) compared to those with controlled HT (MOBILIZE Boston study, n=722, 70 years) Proposed Mechanism: Normal BP and controlled HT individuals have less arterial stiffness and improved baroreflex sensitivity and therefore less OH

23 Ogliari et al, Age Ageing 2015 n=1581 Furthermore higher SBP was correlated with increased survival especially in participants with impairment of functional and cognitive status

24 Systolic Blood Pressure Intervention Trial (SPRINT) (Whelton, J Hypert, USA, 2016 abstract) N =9361, > 50 yrs + additional CV risk factor Excluded DM, stroke, advanced CKD Randomised to Intensive therapy (SBP< 120) or Standard (SBP<140) Primary endpoint composite of CV and CV mortality Results Overall 30% reduction in primary outcome with intensive Rx Stratification in >75 yrs by frailty and gait speed gave similar results Intensive Group led a greater SAEs hypotension, syncope, AKI

25 But... CLARIFY study Lancet 2016 (Vidal-Petiot et al) In people with Coronary Artery Disease: Systolic BP >140 or Diastolic BP >80 associated with increased cardiovascular events Systolic BP <120 or Diastolic BP < 70 associated with cardiovascular events Evidence for a J shaped curve Reduced myocardial perfusion if BP too low

26 ESH & ESC Guidelines 2013 Treatment of HT in Elderly I

27 Relationship between BP and Frailty in Older Hypertensives (Basile 2016, Italy) Inverse relationship between Frailty Index (>0.25) and : Systolic BP Orthostatic Systolic BP Orthostatic Diastolic BP Orthostatic Pulse Pressure Conclusion: Frailer patients appeared to be overtreated according to the new European guidelines

28 Tendency towards increasing polypharmacy over time, with associated risk of adverse events without demonstrable benefit in terms of BP control Treating Hypertension in Dementia Systematic Review, Beishan LC et al, 2014, 6 trials We found no evidence to confirm or refute the hypothesis that treatment of hypertension in people with dementia leads to overall health benefit New Horizons article, Harrison et al 2016 Age Ageing High BP a risk factor for cognitive decline in midlife Low BP a risk factor for cognitive decline in later life Therefore, possible that excessive BP lowering in older people with dementia might harm cognition Treating Hypertension in Care Homes- Systematic Review of Observational studies, Welsh T et al 2014, 16 studies HT is common in care home residents and is commonly treated with anti-hypertensives but with no better BP control

29 My Current Conclusions on Treating Hypertension In Older People in Relation to Falls Risk Conflicting Data (rapidly changing evidence) ARBs, ACEIs, Ca blockers - least harmful or even beneficial? Initiation - high falls risk, monitor carefully Dose and extent of BP control important Frailty and Dementia- reassess target and goals Individualise treatment

30 Introduction Cardiovascular Risk Factors and falls Cardiovascular Medications and Falls Interventions to Reduce FRID

31 Withdrawal of CV Drugs Fotherby et al (1994) withdrew anti-ht drugs in 47 subjects with BP 175/100: OH prevalence compared to the group that stayed on treatment Alsop et al (2001) Withdrawal of all CV drugs led to a 78% reduction in Syncope, Falls and OH No renewal needed in 70% Withdrawal only if BP 120/80

32 Br J ClinPharmacol 2007 Cohort study, n= 139, 1+ prior falls, mean age 78.6 yrs, females 76% Cost saving of 491 per prevented fall (2008)

33 Mrs GH is a 84 year old woman who is having recurrent falls MMSE 20/30 Vascular Parkinsonism CKD-3 AMD Hypertension DH: Bendroflumethiazide 2.5mg, Amlodipine 10mg BP lying 180/90 BP standing immediate 140/70 (slightly dizzy) BP standing 3 mins 175/90 Would you : 1. Reduce antihypertensives? 2. Increase antihypertensives? 3. Make no change?

34

35 Thank You for Listening

What are you trying to achieve? Falls Prevention, Assessment and Management Strategies. Falls can be classified into four main groups:

What are you trying to achieve? Falls Prevention, Assessment and Management Strategies. Falls can be classified into four main groups: What are you trying to achieve? Falls Prevention, Assessment and Management Strategies Dr Adam Darowski Community: Falls risk assessment: Falls risk is 50% per year in 80yr population and higher in those

More information

Hypertension targets in the elderly. Sarah McCracken Consultant Geriatrician North Bristol NHS Trust September 2016

Hypertension targets in the elderly. Sarah McCracken Consultant Geriatrician North Bristol NHS Trust September 2016 Hypertension targets in the elderly Sarah McCracken Consultant Geriatrician North Bristol NHS Trust September 2016 NICE (2011) Aim for a target clinic blood pressure below 150/90 mmhg in people aged 80

More information

Strokes, Falls, Forgetfulness and Frailty Managing the Very Elderly Hypertensive

Strokes, Falls, Forgetfulness and Frailty Managing the Very Elderly Hypertensive Strokes, Falls, Forgetfulness and Frailty Managing the Very Elderly Hypertensive John Potter Professor Ageing and Stroke Medicine University of East Anglia Oh God who knowest us to be set midst great dangers,

More information

Wednesday September 20 th CMT Regional Study Day. Dr Colin Mason, Consultant DME, Addenbrooke s Hospital

Wednesday September 20 th CMT Regional Study Day. Dr Colin Mason, Consultant DME, Addenbrooke s Hospital Wednesday September 20 th CMT Regional Study Day Dr Colin Mason, Consultant DME, Addenbrooke s Hospital Develop a structured approach to a patient presenting with a fall Risk stratify who can go home and

More information

Primary Care Approach for Evaluating the Risk of Falls with Elderly Patients. Danielle Hansen, DO, MS (Med Ed), MHSA

Primary Care Approach for Evaluating the Risk of Falls with Elderly Patients. Danielle Hansen, DO, MS (Med Ed), MHSA Primary Care Approach for Evaluating the Risk of Falls with Elderly Patients Danielle Hansen, DO, MS (Med Ed), MHSA Clinical Assistant Professor, LECOM Associate Director, LECOM Institute for Successful

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

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

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

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 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

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

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

Falls most commonly seen in RACFs are due to tripping, slipping and stumbling (21.6%). Falling down stairs is relatively uncommon in

Falls most commonly seen in RACFs are due to tripping, slipping and stumbling (21.6%). Falling down stairs is relatively uncommon in This Presentation Medications and Falls Dr Peter Tenni M Pharm (Curtin), PhD (UTAS) AACPA Director, CPS A fall is an event which results in a person coming to rest inadvertently on the ground or floor

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

Todd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM

Todd 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 information

JNC Evidence-Based Guidelines for the Management of High Blood Pressure in Adults

JNC Evidence-Based Guidelines for the Management of High Blood Pressure in Adults JNC 8 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults Table of Contents Why Do We Treat Hypertension? Blood Pressure Treatment Goals Initial Therapy Strength of Recommendation

More information

Falls in the Elderly. Causes and solutions.

Falls in the Elderly. Causes and solutions. Falls in the Elderly. Causes and solutions. Brent Tipping Sub-specialist Geriatrician and Specialist Physician Division of Geriatric Medicine University of the Witwatersrand 6 th Annual congress of the

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 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

MANAGEMENT OF HYPERTENSION: TREATMENT THRESHOLDS AND MEDICATION SELECTION

MANAGEMENT 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 information

Blood Pressure Targets: Where are We Now?

Blood Pressure Targets: Where are We Now? Blood Pressure Targets: Where are We Now? Diana Cao, PharmD, BCPS-AQ Cardiology Assistant Professor Department of Clinical & Administrative Sciences California Northstate University College of Pharmacy

More 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

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

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 IN THE ELDERLY A BALANCED APPROACH. Barry Goldlist October 31, 2014

HYPERTENSION IN THE ELDERLY A BALANCED APPROACH. Barry Goldlist October 31, 2014 HYPERTENSION IN THE ELDERLY A BALANCED APPROACH Barry Goldlist October 31, 2014 DISCLOSURE I have not accepted any money for myself from any pharmaceutical company in the 21 st century I have accepted

More 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

By Prof. Khaled El-Rabat

By Prof. Khaled El-Rabat What is The Optimum? By Prof. Khaled El-Rabat Professor of Cardiology - Benha Faculty of Medicine HT. Introduction Despite major worldwide efforts over recent decades directed at diagnosing and treating

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

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

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

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

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

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. 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

MODERN MANAGEMENT OF HYPERTENSION Where Do We Draw the Line? Disclosure. No relevant financial relationships. Blood Pressure and Risk

MODERN MANAGEMENT OF HYPERTENSION Where Do We Draw the Line? Disclosure. No relevant financial relationships. 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 information

Management 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 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 information

Hypotensive susceptibility and antihypertensive drugs Diana Solari Santa Margherita Ligure, 7 aprile 2016

Hypotensive susceptibility and antihypertensive drugs Diana Solari Santa Margherita Ligure, 7 aprile 2016 Hypotensive susceptibility and antihypertensive drugs Diana Solari Santa Margherita Ligure, 7 aprile 2016 Arrhythmologic Center, Department of Cardiology, Lavagna SYNCOPE AND ANTIHYPERTENSIVE DRUGS Many

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

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

, 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

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

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

Management of Hypertension in special groups. DR-Mohammed Salah Assistant Lecturer of Cardiology Mansoura University

Management of Hypertension in special groups. DR-Mohammed Salah Assistant Lecturer of Cardiology Mansoura University Management of Hypertension in special groups BY DR-Mohammed Salah Assistant Lecturer of Cardiology Mansoura University AGENDA SPECIAL GROUPS SPECIFIC DRUDS FOR SPECIAL GROUPS TARGET BP FOR SPECIAL GROUPS:

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

Fall Risk Assessment and Management. Elizabeth A. Phelan, MD, MS Assistant Professor, Medicine/Gerontology October 24, 2007

Fall Risk Assessment and Management. Elizabeth A. Phelan, MD, MS Assistant Professor, Medicine/Gerontology October 24, 2007 Fall Risk Assessment and Management Elizabeth A. Phelan, MD, MS Assistant Professor, Medicine/Gerontology October 24, 2007 Slide 2 OBJECTIVES Know and understand: The importance of falls by older persons

More information

Combination Therapy for Hypertension

Combination Therapy for Hypertension Combination Therapy for Hypertension Se-Joong Rim, MD Cardiology Division, Yonsei University College of Medicine, Seoul, Korea Goals of Therapy Reduce CVD and renal morbidity and mortality. Treat to BP

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

STOPP and START criteria October 2011

STOPP and START criteria October 2011 # START and STOPP are newer criteria to identify potentially inappropriate medications in elderly, including drug drug and drug disease interactions, drugs which increase risk of falls and drugs which

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

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

Update in Hypertension

Update 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 information

DISCLOSURES OUTLINE OUTLINE 9/29/2014 ANTI-HYPERTENSIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE

DISCLOSURES OUTLINE OUTLINE 9/29/2014 ANTI-HYPERTENSIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE ANTI-HYPERTENSIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE DISCLOSURES Editor-in-Chief- Nephrology- UpToDate- (Wolters Klewer) Richard J. Glassock, MD, MACP Geffen School of Medicine at UCLA 1 st Annual Internal

More information

Hypertension in the elderly

Hypertension in the elderly 091 Hypertension in the elderly Hypertension remains widely prevalent and a significant determinant of cardiovascular risk in the elderly population. Several large controlled trials have shown the benefits

More information

HYPERTENSION IN EMERGENCY MEDICINE Michael Jay Bresler, M.D., FACEP

HYPERTENSION IN EMERGENCY MEDICINE Michael Jay Bresler, M.D., FACEP HYPERTENSION IN EMERGENCY MEDICINE Michael Jay Bresler, M.D., FACEP What is normal blood pressure? Prehypertension 130-139/80-90 Compared with normal BP Double the risk for developing hypertension. Lifestyle

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

First line treatment of primary hypertension

First line treatment of primary hypertension First line treatment of primary hypertension Dr. Vijaya Musini Assistant Professor, Dept. Anesthesiology, Pharmacology and Therapeutics Manager, Drug Assessment Working Group Therapeutics Initiative Editor,

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

This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data.

This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data. abcd Clinical Study Synopsis for Public Disclosure This clinical study synopsis is provided in line with s Policy on Transparency and Publication of Clinical Study Data. The synopsis which is part of the

More information

Danno d organo bersaglio e rischio CV. Persiste un ruolo prognostico oltre la patologia d organo?

Danno d organo bersaglio e rischio CV. Persiste un ruolo prognostico oltre la patologia d organo? Danno d organo bersaglio e rischio CV. Persiste un ruolo prognostico oltre la patologia d organo? Prof. Massimo Salvetti Clinica Medica University of Brescia Percieved risk Actual risk Sehestedt et al,

More information

Section 3, Lecture 2

Section 3, Lecture 2 59-291 Section 3, Lecture 2 Diuretics: -increase in Na + excretion (naturesis) Thiazide and Related diuretics -decreased PVR due to decreases muscle contraction -an economical and effective treatment -protect

More information

Prevention of Heart Failure: What s New with Hypertension

Prevention of Heart Failure: What s New with Hypertension Prevention of Heart Failure: What s New with Hypertension Ali AlMasood Prince Sultan Cardiac Center Riyadh 3ed Saudi Heart Failure conference, Jeddah, 13 December 2014 Background 20-30% of Saudi adults

More information

Incidental Findings; Management of patients presenting with high BP. Phil Swales

Incidental 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 information

Disclosures. Learning Objectives. Hypertension: a sprint to the finish Ontario Pharmacists Association 1

Disclosures. Learning Objectives. Hypertension: a sprint to the finish Ontario Pharmacists Association 1 Disclosures I have no current or past relationships with commercial entities I have received a speaker s fee from the Ontario Pharmacists Association for this learning activity Laura Tsang PharmD Sunnybrook

More information

Hypertension in 2015: SPRINT-ing ahead of JNC-8. MAJ Charles Magee, MD MPH FACP Director, WRNMMC Hypertension Clinic

Hypertension in 2015: SPRINT-ing ahead of JNC-8. MAJ Charles Magee, MD MPH FACP Director, WRNMMC Hypertension Clinic Hypertension in 2015: SPRINT-ing ahead of JNC-8 MAJ Charles Magee, MD MPH FACP Director, WRNMMC Hypertension Clinic Conflits of interest? None Disclaimer The opinions contained herein are not to be considered

More information

Hypertension diagnosis (see detail document) Diabetic. Target less than 130/80mmHg

Hypertension 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 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

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 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

New Hypertension Guidelines: Why the change? Neil Brummond, M.D. Avera Medical Group Internal Medicine Sioux Falls, SD

New Hypertension Guidelines: Why the change? Neil Brummond, M.D. Avera Medical Group Internal Medicine Sioux Falls, SD New Hypertension Guidelines: Why the change? Neil Brummond, M.D. Avera Medical Group Internal Medicine Sioux Falls, SD None Disclosures Objectives Understand trend in blood pressure clinical practice guidelines

More information

DECLARATION OF CONFLICT OF INTEREST

DECLARATION OF CONFLICT OF INTEREST DECLARATION OF CONFLICT OF INTEREST The Management of Syncope remains a challenge: Clues from the History Richard Sutton, DSc Emeritus Professor of Cardiology Imperial College, St Mary s Hospital, London,

More information

Implanting a baroreceptor stimulation device for resistant hypertension

Implanting a baroreceptor stimulation device for resistant hypertension NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Interventional procedure consultation document Implanting a baroreceptor stimulation device for resistant hypertension Hypertension (or high blood pressure)

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

Elements for a public summary

Elements for a public summary VI.2 Elements for a public summary VI.2.1Overview of disease epidemiology 1 Losartan is indicated for: Treatment of essential hypertension in adults and in children and adolescent 6 18 years of age. Treatment

More information

Hypertension Pharmacotherapy: A Practical Approach

Hypertension Pharmacotherapy: A Practical Approach Hypertension Pharmacotherapy: A Practical Approach Ronald Victor, MD Burns & Allen Chair in Cardiology Director, The Hypertension Center Associate Director, The Heart Institute Hypertension Center 1. 2.

More information

National Horizon Scanning Centre. Irbesartan (Aprovel) for heart failure with preserved systolic function. August 2008

National Horizon Scanning Centre. Irbesartan (Aprovel) for heart failure with preserved systolic function. August 2008 Irbesartan (Aprovel) for heart failure with preserved systolic function August 2008 This technology summary is based on information available at the time of research and a limited literature search. It

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

Roman Romero-Ortuno *, Matthew DL O Connell, Ciaran Finucane, Christopher Soraghan, Chie Wei Fan and Rose Anne Kenny

Roman Romero-Ortuno *, Matthew DL O Connell, Ciaran Finucane, Christopher Soraghan, Chie Wei Fan and Rose Anne Kenny Romero-Ortuno et al. BMC Geriatrics 2013, 13:73 RESEARCH ARTICLE Open Access Insights into the clinical management of the syndrome of supine hypertension orthostatic hypotension (SH-OH): The Irish Longitudinal

More information

47 Hypertension in Elderly

47 Hypertension in Elderly 47 Hypertension in Elderly YOU DO NOT HEAL OLD AGE; YOU PROTECT IT; YOU PROMOTE IT; YOU EXTEND IT Sir James Sterling Ross Abstract: The prevalence of hypertension rises with age and the complications secondary

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

Strategies to manage medication related falls in older people

Strategies to manage medication related falls in older people Strategies to manage medication related falls in older people ALLEN R. HUANG, MDCM, FRCPC RGPEO Refresher Day, April 5, 2017 www.ottawahospital.on.ca Affiliated with Affilié à DISCLOSURES I have no conflict

More information

International Journal of Advancements in Research & Technology, Volume 2, Issue 6, June-2013 ISSN

International Journal of Advancements in Research & Technology, Volume 2, Issue 6, June-2013 ISSN ISSN 2278-7763 295 Study of Prescriptive Patterns of Antihypertensive Drugs in South India Popuri Rupa Sindhu, Malladi Srinivas Reddy St. Peters Institute of Pharmaceutical Sciences, Hanamkonda, Warangal-506001,

More information

Clinical Studies 129

Clinical Studies 129 Clinical Studies 129 Syncope in migraine. The population-based CAMERA study Roland D. Thijs, 1* Mark C. Kruit, 2* Mark A. van Buchem, 2 Michel D. Ferrari, 1 Lenore J. Launer, 3,4 and J. Gert van Dijk

More information

Update on Falls Prevention Research

Update on Falls Prevention Research Update on Falls Prevention Research Dr Jasmine Menant NSW Falls Prevention Network Rural Forum 17 th October 2014 Acknowledgement: Prof Stephen Lord Recent falls risk factor studies Vascular disease 38.6%

More information

Nurse-sensitive factors in hypertension management

Nurse-sensitive factors in hypertension management Nurse-sensitive factors in hypertension management Hypertension treatment State of the Art Copper Hall 14:45-15:04 02/04/2011 Philippe van de Borne, MD, PhD Department of cardiology ULB-Erasme Hospital

More information

ΑΡΥΙΚΗ 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 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 information

DECLARATION OF CONFLICT OF INTEREST

DECLARATION OF CONFLICT OF INTEREST DECLARATION OF CONFLICT OF INTEREST Is there a mortality risk associated with aspirin use in heart failure? Results from a large community based cohort Margaret Bermingham, Mary-Kate Shanahan, Saki Miwa,

More information

Rational prescribing in the older adult. Assoc Prof Craig Whitehead

Rational prescribing in the older adult. Assoc Prof Craig Whitehead Rational prescribing in the older adult Assoc Prof Craig Whitehead Introduction Physioloical ageing and frailty Medication risks in older adults Drug Burden Anticholinergic and sedative drug burden Cascade

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

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

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

JNC-8. (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure- 8) An Update on Hypertension Guidelines

JNC-8. (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure- 8) An Update on Hypertension Guidelines JNC-8 (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure- 8) An Update on Hypertension Guidelines Derrick Sorweide, DO Assistant Professor of Family Medicine,

More information

A thorough history of falls is important to determine the mechanism of fall, the associated THE FALLING ELDERLY. Psychological trauma.

A thorough history of falls is important to determine the mechanism of fall, the associated THE FALLING ELDERLY. Psychological trauma. T H E M E : E L D E R L Y A N D H O M E H E A L T H C A R E Dr Noor Hadfizah INTRODUCTION Each year, about one third of elderly above the age of 65 years old fall. Falls are so common amongst the elderly

More information

Il punto di vista della SIGG

Il punto di vista della SIGG Congresso Nazionale SIGG Gli anziani: le radici da preservare Roma, 28 novembre/1 dicembre 2018 Meet the Expert SIGG-GIMSI Le nuove linee guida ESC 2018 sulla sincope: una sfida per i geriatri. Cosa non

More information

Update on Falls Prevention Research

Update on Falls Prevention Research Update on Falls Prevention Research Jasmine Menant NSW Falls Prevention Network Rural Forum 26 th March 2015 Acknowledgments: Prof Stephen Lord Recent falls risk factor studies Vascular disease 38.6% of

More information

Every year, a third of Americans over age 65

Every year, a third of Americans over age 65 Falls and mobility problems are not just part of getting old! Every year, a third of Americans over age 65 living in the community suffer a fall, and 50% over the age of 80 fall at least once per year.

More information

Combination therapy Giuseppe M.C. Rosano, MD, PhD, MSc, FESC, FHFA St George s Hospitals NHS Trust University of London

Combination therapy Giuseppe M.C. Rosano, MD, PhD, MSc, FESC, FHFA St George s Hospitals NHS Trust University of London Combination therapy Giuseppe M.C. Rosano, MD, PhD, MSc, FESC, FHFA St George s Hospitals NHS Trust University of London KCS Congress: Impact through collaboration CONTACT: Tel. +254 735 833 803 Email:

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

Director of the Israeli Institute for Quality in Medicine Israeli Medical Association July 1st, 2016

Director of the Israeli Institute for Quality in Medicine Israeli Medical Association July 1st, 2016 The differential effect of Atherosclerosis on end organ damage in adult and elderly patients with CVRF: New Algorithm for Hypertension Diagnosis and Treatment R. Zimlichman, FAHA, FASH, FESC, FESH Chief

More information

Antihypertensive Trial Design ALLHAT

Antihypertensive Trial Design ALLHAT 1 U.S. Department of Health and Human Services Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic National Institutes

More information