The document summarizes the key changes between the 2014 hypertension guidelines (JNC 8) and previous guidelines (JNC 7). The 2014 guidelines lower treatment thresholds based on rigorous evidence from randomized controlled trials. They recommend initiating treatment at SBP/DBP of 140/90 mmHg for those under 60, and 150/90 mmHg for those 60 and over. For those with diabetes or chronic kidney disease, the goal is SBP/DBP under 140/90 mmHg. Thiazide-type diuretics, ACE inhibitors, ARBs, calcium channel blockers are first-line treatments depending on population. The guidelines note limitations around scope and costs/adherence.
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
1. A Case report of Heart Failure
2. Discussion on Heart Failure
3. Role of Peptides in Heart Failure
4. Importance of 30 days in heart failure
5. Role of ENTRESTO in Stable Heart Failure patient (PARADIGM-HF study)(HFrEF)
6. Biomarkers in Heart Failure
7. Role of ARNI in Hospitalized Heart Failure patient (PIONEER-HF study)
8. Role of ARNI in HFpEF (PARAMOUNT Trial)
9. Safety and usefulness of ACEI/ARB/ARNI
10. Role of SGPL2 inhibitors in HF with/without DM
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
1. A Case report of Heart Failure
2. Discussion on Heart Failure
3. Role of Peptides in Heart Failure
4. Importance of 30 days in heart failure
5. Role of ENTRESTO in Stable Heart Failure patient (PARADIGM-HF study)(HFrEF)
6. Biomarkers in Heart Failure
7. Role of ARNI in Hospitalized Heart Failure patient (PIONEER-HF study)
8. Role of ARNI in HFpEF (PARAMOUNT Trial)
9. Safety and usefulness of ACEI/ARB/ARNI
10. Role of SGPL2 inhibitors in HF with/without DM
Blood Pressure Targets 2017.Still Struggling for the Right Answermagdy elmasry
Blood Pressure Targets 2017.Guidelines For Hypertension 2011-2015.Does SPRINT change our approach to BP targets?
SPRINT vs. ACCORD.Updated Hypertension Guidelines Released by ACP, AAFP
Vymada Tablet (ARNI: Angiotensin Receptor Neprilysin Inhibitor) is an anti-hypertensive drug used in combination with Sacubitril & Valsartan to reduce the risk of cardiovascular events in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.
Heart failure Update as per, 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the
Management of Heart Failure and 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
The actual prevalence of RH may be lower than what is
perceived in the literature when triple-A (accuracy of BP
measurement, adherence of medications, and adequacy
of anti-HTN medications) are ensured. It is important to
emphasize that the sea of RH starts when the shore of secondary
HTN is over and the island of RfH is still uncharted. RfH is
emerging as a novel phenotype, and growing evidence suggest
that these patients have sympathetic hyperactivity. However,
the role of beta-blockers and interventions such as RDN and
baroreceptor activation techniques is yet to be studied.
La Dra. Ainara Lozano Bahamonde repasa las novedades incluidas en las últimas guías europeas en insuficiencia cardiaca presentadas en ESC Congress 2021.
Beta Blockers in current cardiovascular practice Praveen Nagula
betablockers are the drug of choice for prevention of progression of heart failure with mortality benefit, after the evolution of neurohormonal regulation as pathogenesis of heart failure
Blood Pressure Targets 2017.Still Struggling for the Right Answermagdy elmasry
Blood Pressure Targets 2017.Guidelines For Hypertension 2011-2015.Does SPRINT change our approach to BP targets?
SPRINT vs. ACCORD.Updated Hypertension Guidelines Released by ACP, AAFP
Vymada Tablet (ARNI: Angiotensin Receptor Neprilysin Inhibitor) is an anti-hypertensive drug used in combination with Sacubitril & Valsartan to reduce the risk of cardiovascular events in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.
Heart failure Update as per, 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the
Management of Heart Failure and 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
The actual prevalence of RH may be lower than what is
perceived in the literature when triple-A (accuracy of BP
measurement, adherence of medications, and adequacy
of anti-HTN medications) are ensured. It is important to
emphasize that the sea of RH starts when the shore of secondary
HTN is over and the island of RfH is still uncharted. RfH is
emerging as a novel phenotype, and growing evidence suggest
that these patients have sympathetic hyperactivity. However,
the role of beta-blockers and interventions such as RDN and
baroreceptor activation techniques is yet to be studied.
La Dra. Ainara Lozano Bahamonde repasa las novedades incluidas en las últimas guías europeas en insuficiencia cardiaca presentadas en ESC Congress 2021.
Beta Blockers in current cardiovascular practice Praveen Nagula
betablockers are the drug of choice for prevention of progression of heart failure with mortality benefit, after the evolution of neurohormonal regulation as pathogenesis of heart failure
This talk address the BP guidelines from world societies and also from Taiwan Society of Cardiology (TSOC). See the outline below:
TSOC 2010
ESH/ESC 2013
ASH/ISH 2013
JNC 8 2014
CHEP 2015
TSOC 2015
European Society of Hypertension 2013 Hypertension guidelines presentation in...JAFAR ALSAID
Summary of the European Society of Hypertension 2013 Hypertension Guidelines presented during the Eighth Hypertension and Cardiovascular highlight session in Bahrain on Sept. 11th 2013.
Recommendation 1
In the general population aged ≥60 years, initiate pharmacologic treatment to lower blood pressure (BP) at systolic blood pressure (SBP) ≥150 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg and treat to a goal SBP <150><90><140><60><90><60><140><140><90><140><90 mm Hg. (Expert Opinion – Grade E)
Recommendation 6
In the general nonblack population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB). (Moderate Recommendation – Grade B)
Recommendation 7
In the general black population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or CCB. (For general black population: Moderate Recommendation – Grade B; for black patients with diabetes: Weak Recommendation – Grade C)
Recommendation 8
In the population aged ≥18 years with CKD, initial (or add-on) antihypertensive treatment should include an ACEI or ARB to improve kidney outcomes. This applies to all CKD patients with hypertension regardless of race or diabetes status. (Moderate Recommendation – Grade B)
Recommendation 9
The main objective of hypertension treatment is to attain and maintain goal BP. If goal BP is not reached within a month of treatment, increase the dose of the initial drug or add a second drug from one of the classes in recommendation 6 (thiazide-type diuretic, CCB, ACEI, or ARB). The clinician should continue to assess BP and adjust the treatment regimen until goal BP is reached. If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. Do not use an ACEI and an ARB together in the same patient. If goal BP cannot be reached using only the drugs in recommendation 6 because of a contraindication or the need to use more than 3 drugs to reach goal BP, antihypertensive drugs from other classes can be used. Referral to a hypertension specialist may be indicated for patients in whom goal BP cannot be attained using the above strategy or for the management of complicated patients for whom additional clinical consultation is needed. (Expert Opinion – Grade E)
Combination Therapy In Hypertension - Dr Vivek Baliga PresentationDr Vivek Baliga
Dr Vivek Baliga of Baliga Diagnostics, Bangalore, discusses the common combination therapies used in the management of hypertension in clinical practice.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
1. New 2014 Hypertension Guidelines
Evidence Based Confusion?
Asso: Professor Kyaw Soe Win
MBBS, MMedSc (Int Med), MRCPUK, FRCP (Edin), FAsCC, FAPSIC
6th July 2014
12. Recommendations: Hypertension/Blood Pressure
Control
AADDAA 22001144
Goals
People with diabetes and hypertension
should be treated to a systolic blood pressure
goal of <140 mmHg
Lower systolic targets, such as <130 mmHg,
may be appropriate for certain individuals,
such as younger patients, if it can be
achieved without undue treatment burden
Patients with diabetes should be treated to a
diastolic blood pressure <80 mmHg
ADA. VI. Prevention, Management of Complications. Diabetes Care 2014;37(suppl 1):S36
13. Step 1 Step 2
JNC-1 (1977)
Stepped Care
Diuretic Add methyldopa, reserpine, or propranolol
JNC-2 (1980)
Stepped Care
Diuretic Adrenergic-inhibiting agents (clonidine, methyldopa,
beta blocker, alpha blocker, )
JNC-3 (1984)
Stepped Care
Less than full dose of diuretic or beta
blocker
Add small dose of adrenergic-inhibiting agent or
thiazide-type diuretic
JNC-4 (1988)
Individualized Stepped
Care
Diuretic, beta blocker, calcium channel
blocker, or ACE inhibitor
Add second drug of another class, increase dose of
first drug, or substitute drug of different class
JNC-5 (1993) Diuretic or beta blocker
Alternative therapy: ACE inhibitor, CCB,
beta blocker, alpha blocker
Increase dose or substitute another drug, or add a
second agent from a different class
JNC-6 (1997) Uncomplicated hypertension: diuretic,
beta blocker
Specific indications for ACE inhibitor, ARB, alpha-beta
blocker, beta-blocker, CCB, and diuretic
Substitute another drug or add second agent
Low-dose combination therapy may be appropriate
initial therapy
ACE= angiotensin-converting enzyme; ARB= angiotensin II receptor blocker; CCB= calcium channel blocker
SOURCE: MOSER 2002
14.
15. Blood Pressure Classification JNC 7 2003
BP Classification SBP mmHg* DBP mmHg Lifestyle
Modification
Drug
Therapy**
Normal <120 and <80 Encourage No
Prehypertension 120-139 or 80-89 Yes No
Stage 1
Hypertension 140-159 or 90-99 Yes Single
Agent
Stage 2
Hypertension ≥ 160 or ≥ 100 Yes Combo
*Treatment determined by highest BP category; **Consider treatment for compelling
indications regardless of BP
JNC 7 Express. JAMA. 2003 Sep 10; 290(10):1314
16. Algorithm for Treatment of Hypertension
Not at Goal Blood Pressure (<140/90 mmHg)
(<130/80 mmHg for those with diabetes or chronic kidney disease)
Initial Drug Choices
With Compelling
Indications
Drug(s) for the compelling
indications
Other antihypertensive drugs
(diuretics, ACEI, ARB, BB, CCB)
as needed.
Lifestyle Modifications
Without Compelling
Stage 2 HTN (SBP >160 or DBP
>100 mmHg)
2-drug combination for most
(usually thiazide-type diuretic
and
ACEI, or ARB, or BB, or CCB)
Stage 1 HTN (SBP 140–159 or
DBP 90–99 mmHg)
Thiazide-type diuretics for most.
May consider ACEI, ARB, BB,
CCB, or combination.
Indications
Not at Goal
Blood Pressure
Optimize dosages or add additional drugs
until goal blood pressure is achieved.
Consider consultation with hypertension
JNC 7 Express. JAMA. 2003 Sep 10; 290(10):1314
specialist.
17.
18. What to choose first?
Initial antihypertensive therapy without
compelling indications
JNC 6: Diuretic or a beta-blocker
JNC 7: Thiazide-type diuretics
Most outcome trials base antihypertensive
therapy on thiazides
JNC 7 Express. JAMA. 2003 Sep 10; 290(10):1314
23. This report takes a rigorous, evidence-based
approach to recommend treatment thresholds,
goals, and medications in the management of
hypertension in adults.
Evidence was drawn from randomized controlled
trials, which represent the gold standard for
determining efficacy and effectiveness.
Evidence quality and recommendations were
graded based on their effect on important
outcomes.
24. Questions Guiding the Evidence Review
This evidence-based hypertension guideline focuses on the panel’s 3
highest-Ranked questions related to high BP management .
1. In adults with hypertension, does initiating antihypertensive
pharmacologic therapy at specific BP thresholds improve health
outcomes? (how low should you go)
2. In adults with hypertension, does treatment with antihypertensive
pharmacologic therapy to a specified BP goal lead to improvements
in health outcomes? (when to initiate drug treatment)
3. In adults with hypertension, do various antihypertensive drugs or drug
classes differ in comparative benefits and harms on specific health
outcomes? (How do we get there?)
Nine recommendations are made reflecting these questions.
25.
26.
27. Recommendation 1
In the general population aged 60 years or older, initiate
pharmacologic treatment to lower BP at systolic blood
pressure (SBP) of 150 mmHg or higher or diastolic blood
pressure (DBP) of 90mmHg or higher and treat to a goal SBP
lower than 150mmHg and goal DBP lower than 90mmHg.
Recommendation 2
In the general population <60 years, initiate
pharmacologic treatment to lower BP at DBP 90mmHg and
treat to a goal DBP <90mmHg.
Recommendation 3
In the general population <60 years, initiate
pharmacologic treatment to lower BP at SBP 140mmHg and
treat to a goal SBP <140mmHg.
2014 Evidence Based Guideline for management of High Blood Pressure in Adults (JNC
8)
28. Recommendation 4
In the population aged 18 years with chronic
kidney disease (CKD), initiate pharmacologic
treatment to lower BP at SBP 140mmHg or DBP
90mmHg and treat to goal SBP<140mmHg and goal
DBP<90mmHg.
Recommendation 5
In the population aged 18years with diabetes,
initiate pharmacologic treatment to lower BP at SBP
140mmHg or DBP 90mmHg and treat to a goal SBP
<140mmHg and goal DBP <90mmHg.
2014 Evidence Based Guideline for management of High Blood Pressure in Adults (JNC
8)
29. Recommendation 6
In the general non-black population, including those with
diabetes, initial antihypertensive treatment should include a
thiazide-type diuretic, calcium channel blocker (CCB),
angiotensin-converting enzyme inhibitor(ACEI), or
angiotensin receptor blocker (ARB).
Recommendation 7
In the general black population, including those with
diabetes, initial antihypertensive treatment should include a
thiazide-type diuretic or CCB.
Recommendation 8
In the population aged 18 years with CKD, initial (or add-on)
antihypertensive treatment should include an ACEI or
ARB to improve kidney outcomes. This applies to all CKD
patients with hypertension regardless of race or diabetes
status.
2014 Evidence Based Guideline for management of High Blood Pressure in Adults (JNC
8)
30. Recommendation 9
The main objective of hypertension treatment is to attain
and maintain goal BP. If goal BP is not reached within a month
of treatment, increase the dose of the initial drug or add a
second drug from one of the classes.
If goal BP cannot be reached with 2 drugs, add and titrate a
third drug from the list provided. Do not use an ACEI and an
ARB together in the same patient.
If goal BP cannot be reached using only the drugs in
recommendation 6 because of a contraindication or the need to
use more than 3 drugs to reach goal BP, antihypertensive drugs
from other classes can be used.
Referral to a hypertension specialist may be indicated for
patients in whom goal BP cannot be attained using the above
strategy or for the management of complicated patients for
whom additional clinical consultation is needed.
2014 Evidence Based Guideline for management of High Blood Pressure in Adults (JNC
8)
31. 2014 Evidence Based Guideline for management of High Blood Pressure in Adults (JNC
8)
32. 2014 Evidence Based Guideline for management of High Blood Pressure in Adults (JNC
8)
33. 2014 Evidence Based Guideline for management of High Blood Pressure in Adults (JNC
8)
34. 2014 Evidence Based Guideline for management of High Blood Pressure in Adults (JNC
8)
35. 2014 Evidence Based Guideline for management of High Blood Pressure in Adults (JNC
8)
36.
37. Limitations
This evidence-based guideline for the management of
high BP in adults is not a comprehensive guideline and is
limited in scope because of the focused evidence review
to address the 3 specific questions .
Clinicians often provide care for patients with numerous
comorbidities or other important issues related to
hypertension, but the decision was made to focus on 3
questions considered to be relevant to most physicians
and patients.
38. Limitations
Treatment adherence and medication costs were
thought to be beyond the scope of this review, but
the panel acknowledges the importance of both
issues.
The evidence review did not include observational
studies, systematic reviews, or meta-analyses, and
the panel did not conduct its own meta-analysis
based on prespecified inclusion criteria.
39. Limitations
Clinical guidelines are at the intersection between
research evidence and clinical actions that can improve
patient outcomes.
these recommendations are not a substitute for
clinical judgment, and decisions about care must
carefully consider and incorporate the clinical
characteristics and circumstances of each individual
patient.
the algorithm will facilitate implementation and be
useful to busy clinicians
40. Comparison of Current Recommendations
With JNC 7 Guidelines
Topic JNC 7 2014 Hypertension guideline
Methodology Nonsystematic literature
review by expert committee
including a range of study
designs Recommendations
based on consensus
Initial systematic review by methodologists
restricted to RCT evidence
Subsequent review of RCT evidence and
recommendations by the panel according to
a standardized protocol
Definitions Defined hypertension and
prehypertension
Definitions of hypertension and
prehypertension not addressed, but
thresholds for pharmacologic treatment
were defined
Treatment
goals
Separate treatment goals
defined for “uncomplicated”
hypertension and for subsets
with various comorbid
conditions (diabetes and
CKD)
Similar treatment goals defined for all
hypertensive populations except when
evidence review supports different goals for
a particular subpopulation
41. Comparison of Current Recommendations
With JNC 7 Guidelines
Topic JNC 7 2014 Hypertension guideline
Drug
therapy
Recommended 5 classes to be
considered as initial therapy but
recommended thiazide-type diuretics
as initial therapy for most patients
without compelling indication for
another class
Specified particular antihypertensive
medication classes for patients with
compelling indications, ie, diabetes,
CKD, heart failure, myocardial
infarction, stroke, and high CVD risk
Included a comprehensive table of oral
antihypertensive drugs including
names and usual dose ranges
Recommended selection among 4
specific medication classes (ACEI
or ARB, CCB or diuretics) and doses
based on RCT evidence
Recommended specific medication
classes based on evidence review
for racial, CKD, and diabetic
subgroups
Panel created a table of drugs and
doses used in the outcome trials
42. Comparison of Current Recommendations
With JNC 7 Guidelines
Topic JNC 7 2014 Hypertension guideline
Scope of
topics
Addressed multiple issues (blood
pressure measurement methods,
patient evaluation components,
secondary hypertension, adherence
to regimens, resistant hypertension,
and hypertension in special
populations) based on literature
review and expert opinion
Evidence review of RCTs addressed
a limited number of questions,
those judged by the panel to be of
highest priority.
Review
process
prior to
publication
Reviewed by the National High Blood
Pressure Education Program
Coordinating Committee, a coalition of
39 major professional, public,
and voluntary organizations and 7
federal agencies
Reviewed by experts including
those affiliated with professional
and public organizations and
federal agencies; no official
sponsorship by any organization
should be inferred
43.
44.
45. Conclusion (my opinion)
•The BP for everyone will be <140/90 mmHg
• BP for those >60- <150/90 mmHg
• Combinations of RAS blockers with thiazide
diuretics or RAS blockers and dihydropyridine
CCBs are acceptable first line combos to get
BP to goal, if >20/10mmHg above goal
This set of six slides summarize recommendations for screening and diagnosis, goals, and treatment for hypertension/blood pressure control in patients with diabetes
Slide 2 of 6 – Goals
People with diabetes and hypertension should be treated to a systolic blood pressure (SBP) goal of &lt;140 mmHg (B)
Lower systolic targets, such as &lt;130 mmHg, may be appropriate for certain individuals, such as younger patients, if it can be achieved without undue treatment burden (C)
Patients with diabetes should be treated to a diastolic blood pressure (DBP) &lt;80 mmHg (B)