- JNC 8 updated hypertension guidelines in 2014, recommending initiating pharmacologic treatment for those aged ≥60 years with SBP ≥150 mmHg or DBP ≥90 mmHg, treating to a goal of <150/90 mmHg. For those <60 years or with diabetes or CKD, treatment should begin for SBP ≥140 mmHg or DBP ≥90 mmHg, treating to a goal of <140/90 mmHg.
- Additional recommendations included treating to a goal of <130/80 mmHg for those with CKD and proteinuria, and using ACE inhibitors, ARBs, calcium channel blockers, or thiazide diuretics as initial treatment depending on race and comor
The document summarizes the recommendations of the 2014 JNC 8 guidelines for treatment of hypertension. It discusses:
1) The JNC 8 recommendation to initiate pharmacologic treatment for those aged 60 and older with a systolic blood pressure of 150 mm Hg or higher, and to treat to a goal of under 150 mm Hg.
2) Evidence from trials supporting this recommendation showing reduced risks of stroke, heart failure, and coronary heart disease with treatment to a goal of under 150 mm Hg.
3) Arguments against recommending treatment to lower goals not proven in clinical trials, such as unnecessary exposure to medication side effects and polypharmacy in the elderly.
Hypertension- Update on current guideline 02.18.16Thu Nguyen
The presentation provided an overview of current hypertension guidelines, discussing the JNC7, JNC8, and American/International Society of Hypertension guidelines. It summarized the SPRINT clinical trial which evaluated maintaining a systolic blood pressure of 120 mmHg among adults aged 50+. The presentation also briefly touched on reimbursement issues around guideline compliance and ended with an opportunity for questions.
Untreated high blood pressure can lead to serious health complications. The 2017 guidelines from the American College of Cardiology and American Heart Association recommend evaluating and diagnosing hypertension based on multiple blood pressure readings on separate occasions. Once diagnosed, lifestyle changes and medication are recommended for management. First-line drug options include thiazide diuretics, calcium channel blockers, ACE inhibitors, and ARBs. The guidelines aim to help prevent disability and death from hypertension-related conditions like heart disease and stroke.
1) The SPRINT trial was a randomized controlled trial that compared an intensive blood pressure treatment target of less than 120 mmHg to a standard target of less than 140 mmHg. 9,361 participants aged 50 and older with high cardiovascular risk were enrolled and followed for a median of 3.26 years.
2) The primary outcome was a composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. Key secondary outcomes included all-cause mortality and renal outcomes.
3) Results found that the intensive treatment target reduced the primary composite outcome by 25% and all-cause mortality by 27%, showing benefit of the lower blood pressure target. The trial was stopped early due
This document summarizes guidelines from the Eighth Joint National Committee (JNC 8) on the prevention, detection, evaluation, and treatment of high blood pressure. It provides recommendations on when to initiate pharmacologic treatment based on age, race, presence of diabetes or chronic kidney disease. It recommends treating to a blood pressure goal of less than 150/90 mmHg for those aged 60 or older, and less than 140/90 mmHg for others. It also provides guidance on first-line antihypertensive drug classes based on patient characteristics.
The 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults provides updated recommendations and definitions. Key points include:
- Hypertension is defined as blood pressure at or above 130/80 mmHg. It is categorized into elevated, stage 1, and stage 2 levels based on systolic and diastolic blood pressure readings.
- Out-of-office blood pressure measurements through ambulatory blood pressure monitoring and home monitoring are recommended to confirm a diagnosis of hypertension and guide treatment.
- Proper techniques should be followed for accurate blood pressure measurement and documentation in the office, including using the correct cuff size and properly preparing the patient.
This document reviews US hypertension management guidelines and recommendations for the future. It summarizes the key recommendation from JNC 8 to initiate pharmacologic treatment for those aged 60 and older with a systolic BP of 150 mm Hg or higher or a diastolic BP of 90 mm Hg or higher, and to treat to a goal of under 150/90 mm Hg systolic/diastolic BP. This recommendation is based on trials showing benefits of treating elderly patients to lower BP targets, though evidence is strongest for those over 80. New evidence from the SPRINT trial contradicts JNC 8 and supports even lower BP targets.
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
The document summarizes the recommendations of the 2014 JNC 8 guidelines for treatment of hypertension. It discusses:
1) The JNC 8 recommendation to initiate pharmacologic treatment for those aged 60 and older with a systolic blood pressure of 150 mm Hg or higher, and to treat to a goal of under 150 mm Hg.
2) Evidence from trials supporting this recommendation showing reduced risks of stroke, heart failure, and coronary heart disease with treatment to a goal of under 150 mm Hg.
3) Arguments against recommending treatment to lower goals not proven in clinical trials, such as unnecessary exposure to medication side effects and polypharmacy in the elderly.
Hypertension- Update on current guideline 02.18.16Thu Nguyen
The presentation provided an overview of current hypertension guidelines, discussing the JNC7, JNC8, and American/International Society of Hypertension guidelines. It summarized the SPRINT clinical trial which evaluated maintaining a systolic blood pressure of 120 mmHg among adults aged 50+. The presentation also briefly touched on reimbursement issues around guideline compliance and ended with an opportunity for questions.
Untreated high blood pressure can lead to serious health complications. The 2017 guidelines from the American College of Cardiology and American Heart Association recommend evaluating and diagnosing hypertension based on multiple blood pressure readings on separate occasions. Once diagnosed, lifestyle changes and medication are recommended for management. First-line drug options include thiazide diuretics, calcium channel blockers, ACE inhibitors, and ARBs. The guidelines aim to help prevent disability and death from hypertension-related conditions like heart disease and stroke.
1) The SPRINT trial was a randomized controlled trial that compared an intensive blood pressure treatment target of less than 120 mmHg to a standard target of less than 140 mmHg. 9,361 participants aged 50 and older with high cardiovascular risk were enrolled and followed for a median of 3.26 years.
2) The primary outcome was a composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. Key secondary outcomes included all-cause mortality and renal outcomes.
3) Results found that the intensive treatment target reduced the primary composite outcome by 25% and all-cause mortality by 27%, showing benefit of the lower blood pressure target. The trial was stopped early due
This document summarizes guidelines from the Eighth Joint National Committee (JNC 8) on the prevention, detection, evaluation, and treatment of high blood pressure. It provides recommendations on when to initiate pharmacologic treatment based on age, race, presence of diabetes or chronic kidney disease. It recommends treating to a blood pressure goal of less than 150/90 mmHg for those aged 60 or older, and less than 140/90 mmHg for others. It also provides guidance on first-line antihypertensive drug classes based on patient characteristics.
The 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults provides updated recommendations and definitions. Key points include:
- Hypertension is defined as blood pressure at or above 130/80 mmHg. It is categorized into elevated, stage 1, and stage 2 levels based on systolic and diastolic blood pressure readings.
- Out-of-office blood pressure measurements through ambulatory blood pressure monitoring and home monitoring are recommended to confirm a diagnosis of hypertension and guide treatment.
- Proper techniques should be followed for accurate blood pressure measurement and documentation in the office, including using the correct cuff size and properly preparing the patient.
This document reviews US hypertension management guidelines and recommendations for the future. It summarizes the key recommendation from JNC 8 to initiate pharmacologic treatment for those aged 60 and older with a systolic BP of 150 mm Hg or higher or a diastolic BP of 90 mm Hg or higher, and to treat to a goal of under 150/90 mm Hg systolic/diastolic BP. This recommendation is based on trials showing benefits of treating elderly patients to lower BP targets, though evidence is strongest for those over 80. New evidence from the SPRINT trial contradicts JNC 8 and supports even lower BP targets.
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
The document summarizes guidelines from various organizations on blood pressure targets from 2011-2015. It notes there has been confusion due to the multitude of guidelines from respected bodies. The JNC 8 guideline relaxed the target from 140/90 mmHg to 150/90 mmHg for those over 60, which was controversial. More recent guidelines in 2015 from the AHA/ACC/ASH set a target of <140/90 mmHg for those with CAD and <130/80 mmHg may be appropriate for some high risk groups. New hypertension guidelines are anticipated to be released in 2016 by several medical societies to update the JNC 7 guidelines from 2003.
Cap nhat-dieu-tri-tang-huyet-ap-2018-tam-quan-trong-cua-uc-che-calci-pham-ngu...Vinh Pham Nguyen
1) The document discusses the importance of calcium channel blockers in treating hypertension. It focuses on their role as one of the main drug classes for controlling blood pressure.
2) Key points covered include calcium channel blockers inhibiting calcium entry into vascular smooth muscle cells, which causes vasodilation and lowers blood pressure. They are considered very effective antihypertensive agents.
3) The document emphasizes that calcium channel blockers should be part of the initial drug treatment regimen for most patients with hypertension according to current guidelines. They are an essential tool for physicians in managing hypertension.
The SPRINT study found that treating systolic blood pressure to 120 mm Hg rather than 140 mm Hg significantly reduced mortality and cardiovascular events such as heart attack and stroke. This challenges the current JNC 8 guideline target of 140 mm Hg and below. The PATHWAY2 study found that adding spironolactone was more effective at reducing blood pressure than other drugs for patients resistant to three-drug treatment. Research also showed that ACE inhibitors resulted in poorer cardiovascular outcomes for black hypertensive patients compared to other antihypertensive drugs.
The document summarizes the SPRINT trial which compared intensive blood pressure control (target SBP <120 mm Hg) to standard treatment (target SBP 135-139 mm Hg) in patients at high risk for cardiovascular disease but without diabetes or history of stroke. The trial found that intensive treatment reduced the occurrence of heart attacks, heart failure, and death by about 25% compared to standard treatment. However, intensive treatment also increased the risk of acute kidney injury, particularly in those without chronic kidney disease at baseline. Overall, the trial demonstrated that intensive blood pressure control provides significant cardiovascular benefits for high-risk patients.
The document discusses guidelines for the management of high blood pressure from JNC 8 (2014). It provides:
1) Recommendations on when to initiate pharmacologic treatment based on systolic and diastolic blood pressure thresholds for general populations aged 60 years and older, younger than 60 years, and those with chronic kidney disease or diabetes.
2) Recommendations on treatment goals for different populations.
3) Recommendations on initial drug treatment options based on population, including thiazide-type diuretics, calcium channel blockers, ACE inhibitors, and ARBs.
JNC VIII GUIDELINES FOR MANAGEMENT OF BLOOD PRESSURE 2013Praveen Nagula
This document summarizes the 2014 evidence-based guidelines for managing high blood pressure from the JNC 8 panel. The guidelines make 9 recommendations regarding treatment thresholds, goals, and medication selection based on rigorous evidence from randomized controlled trials. The recommendations address treatment for adults aged 60 and older, those under 60, those with chronic kidney disease or diabetes, and the general black population. Initial treatment should include a thiazide diuretic, calcium channel blocker, ACE inhibitor, or ARB based on trial evidence demonstrating the efficacy of these drug classes in lowering blood pressure and reducing cardiovascular events.
This document discusses guidelines for the treatment of hypertension from multiple organizations and studies. It provides recommendations for treatment thresholds, goals, and initial drug choices. For the case patient, a 58-year-old African American woman with diabetes and dyslipidemia, the guidelines recommend a goal blood pressure of <140/90 mmHg and initial drug treatment with a thiazide diuretic or calcium channel blocker. Lifestyle modifications including dietary changes, exercise, weight control, and limiting alcohol and salt are also emphasized.
The document summarizes guidelines from JNC 8 (2014) on the management of hypertension. It provides 3 key recommendations from JNC 8:
1) Treatment should begin for general population aged ≥60 years with SBP ≥150 mmHg or DBP ≥90 mmHg, and for those <60 years with SBP ≥140 mmHg or DBP ≥90 mmHg.
2) The treatment goal for non-diabetic, non-CKD patients is SBP <150 mmHg and DBP <90 mmHg. Lower goals may apply if no adverse effects.
3) Initial treatment should include ACE inhibitors, angiotensin receptor blockers, calcium channel blockers or thiaz
New 2017 aha acc hypertension guidelinesgisa_legal
The new Hypertension Guideline lowers the threshold for diagnosing hypertension from 140/90 mm Hg to 130/80 mm Hg. This means nearly half of American adults now have hypertension based on the new definition. The guideline provides new treatment recommendations including lifestyle changes and BP-lowering medications. It also emphasizes accurate BP measurement and self-monitoring by patients at home.
Challenge in management of hypertensionSolidaSakhan
1. The document discusses challenges in managing hypertension and compares blood pressure targets from different clinical practice guidelines.
2. It outlines methods for accurately measuring blood pressure, including office, home, and ambulatory blood pressure monitoring to diagnose conditions like white coat and masked hypertension.
3. Guidelines discussed recommend targeting a systolic blood pressure of 130 mmHg or lower, though the optimal level remains debated, as lower targets must be balanced with potential adverse effects from treatment. Lifestyle modifications and medication are important for managing hypertension.
This document summarizes recommendations from experts appointed to the Eighth Joint National Committee (JNC 8) on evidence-based management of high blood pressure in adults. Key recommendations include: 1) initiating pharmacologic treatment for those aged ≥60 years with BP ≥150/90 mmHg, treating to <150/90 mmHg; 2) initial treatment includes thiazide diuretics, calcium channel blockers, ACE inhibitors, or ARBs; 3) for those with chronic kidney disease, include an ACE inhibitor or ARB to improve kidney outcomes. The report aims to provide guidance on BP thresholds, goals, and medications based on rigorous review of randomized controlled trial evidence.
The document summarizes guidelines from the International Society of Hypertension (ISH), World Health Organization (WHO), American College of Cardiology/American Heart Association (ACC/AHA), and European Society of Cardiology/European Society of Hypertension (ESC/ESH) on the diagnosis and treatment of hypertension. It compares the guidelines on prevalence of hypertension, treatment thresholds and targets, drug choice and sequencing, and targets for specific patient groups. While the guidelines have some differences, they also have many similarities, including treatment targets of under 140/90 mmHg for most patients and under 130/80 mmHg for high-risk groups.
The document discusses updated guidelines for diagnosing and treating hypertension that were released in 2017. Some key points:
- The new guidelines lower the threshold for stage 1 hypertension to 130/80 mm Hg from 140/90 mm Hg. This means nearly half of US adults now have hypertension based on these guidelines.
- Lifetime risk of developing hypertension is approximately 90% for adults aged 55-65 based on data from the Framingham Heart Study.
- Self-monitoring and ambulatory blood pressure monitoring provide benefits over office-based measurements alone for managing hypertension.
- Lifestyle modifications such as weight loss, reduced sodium intake, increased potassium and physical activity are recommended as first-line treatment for many with elevated blood pressure
This document provides guidance on the management of hypertension. It begins with educational objectives and a case study example. It then reviews the magnitude of hypertension, definitions of true hypertension versus white coat hypertension, and the role of ambulatory blood pressure monitoring. Guidelines for diagnosing and staging hypertension from ACC/AHA and JNC-8 are presented. Non-pharmacologic and pharmacologic treatment options are discussed, including diuretics, ACE inhibitors, ARBs, beta blockers, calcium channel blockers, and vasodilators. Resistant hypertension, hypertensive crises, and hypertension management in specific clinical contexts like stroke are also addressed. Recommendations are provided for evaluating and managing different patient cases.
1) The document compares the 2017 guidelines for hypertension from Hypertension Canada and the American Heart Association/American College of Cardiology.
2) There are some differences in definitions of elevated blood pressure and hypertension thresholds. Hypertension Canada guidelines are more evidence-based while AHA/ACC guidelines are more pragmatic.
3) Both emphasize accurate blood pressure measurement and recommend similar non-pharmacological interventions like weight loss, diet changes, and increased physical activity. However, they differ on when to initiate drug therapy and targets for specific patient groups.
The panel recommends the following for treatment of hypertension in adults:
- For those aged 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For those aged 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For those younger than 60 years with diabetes or chronic kidney disease, treat to a blood pressure goal of less than 140/90 mm Hg.
- Initiate treatment with one of four classes of antihypertensive drugs (angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic). The most appropriate first
The panel recommends the following for treatment of hypertension in adults:
- For those aged 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For those aged 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For those younger than 60 years with diabetes or chronic kidney disease, treat to a blood pressure goal of less than 140/90 mm Hg.
- Initiate treatment with one of four classes of antihypertensive drugs (angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic).
- For non
Eighth Joint National Committee (JNC 8) - Blood Pressure in AdultsSandru Acevedo MD
The panel recommends the following for treatment of hypertension in adults:
- For patients aged 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For patients aged 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For nonblack patients, including those with diabetes, initially treat with a thiazide-type diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker.
- For black patients, including those with diabetes, initially treat with a calcium channel blocker or thiazide-type diuretic.
Jnc 8 guidelines for management of high blood pressure: Lets compare with JNC 7Dr. Afzal Haq Asif
This guideline from the Eighth Joint National Committee provides evidence-based recommendations for the management of high blood pressure in adults. There is strong evidence that treating hypertensive patients aged 60 years or older to a blood pressure goal of less than 150/90 mm Hg and those aged 30-59 years to a goal of less than 90 mm Hg improves health outcomes. For hypertensive patients under age 60, a goal of less than 140/90 mm Hg is recommended based on expert opinion due to insufficient evidence for specific systolic and diastolic goals. The guideline also recommends initiating drug treatment for hypertension with certain classes of medications, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium
The panel recommends the following for treatment of hypertension in adults:
- For ages 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For ages 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For those under 30, or ages 60 or older with diabetes or kidney disease, treat to a goal of less than 140/90 mm Hg.
- Initial drug treatment should include a thiazide-type diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker.
- For nonblack populations, including those with diabetes, consider a
Anemia is a major health problem in India, especially among women. Some key points about anemia from the document include:
- Anemia is defined as a decrease in red blood cells or hemoglobin in the blood. It can be caused by blood loss, impaired red blood cell production, or increased red blood cell destruction.
- The document classifies anemias based on cause (hypo proliferative, hemorrhagic, hemolytic) and cell size (microcytic, normocytic, macrocytic). Common causes discussed are iron deficiency, B12/folate deficiency, aplastic anemia, and hemolytic anemia.
- Signs and symptoms of anemia
The document summarizes guidelines from various organizations on blood pressure targets from 2011-2015. It notes there has been confusion due to the multitude of guidelines from respected bodies. The JNC 8 guideline relaxed the target from 140/90 mmHg to 150/90 mmHg for those over 60, which was controversial. More recent guidelines in 2015 from the AHA/ACC/ASH set a target of <140/90 mmHg for those with CAD and <130/80 mmHg may be appropriate for some high risk groups. New hypertension guidelines are anticipated to be released in 2016 by several medical societies to update the JNC 7 guidelines from 2003.
Cap nhat-dieu-tri-tang-huyet-ap-2018-tam-quan-trong-cua-uc-che-calci-pham-ngu...Vinh Pham Nguyen
1) The document discusses the importance of calcium channel blockers in treating hypertension. It focuses on their role as one of the main drug classes for controlling blood pressure.
2) Key points covered include calcium channel blockers inhibiting calcium entry into vascular smooth muscle cells, which causes vasodilation and lowers blood pressure. They are considered very effective antihypertensive agents.
3) The document emphasizes that calcium channel blockers should be part of the initial drug treatment regimen for most patients with hypertension according to current guidelines. They are an essential tool for physicians in managing hypertension.
The SPRINT study found that treating systolic blood pressure to 120 mm Hg rather than 140 mm Hg significantly reduced mortality and cardiovascular events such as heart attack and stroke. This challenges the current JNC 8 guideline target of 140 mm Hg and below. The PATHWAY2 study found that adding spironolactone was more effective at reducing blood pressure than other drugs for patients resistant to three-drug treatment. Research also showed that ACE inhibitors resulted in poorer cardiovascular outcomes for black hypertensive patients compared to other antihypertensive drugs.
The document summarizes the SPRINT trial which compared intensive blood pressure control (target SBP <120 mm Hg) to standard treatment (target SBP 135-139 mm Hg) in patients at high risk for cardiovascular disease but without diabetes or history of stroke. The trial found that intensive treatment reduced the occurrence of heart attacks, heart failure, and death by about 25% compared to standard treatment. However, intensive treatment also increased the risk of acute kidney injury, particularly in those without chronic kidney disease at baseline. Overall, the trial demonstrated that intensive blood pressure control provides significant cardiovascular benefits for high-risk patients.
The document discusses guidelines for the management of high blood pressure from JNC 8 (2014). It provides:
1) Recommendations on when to initiate pharmacologic treatment based on systolic and diastolic blood pressure thresholds for general populations aged 60 years and older, younger than 60 years, and those with chronic kidney disease or diabetes.
2) Recommendations on treatment goals for different populations.
3) Recommendations on initial drug treatment options based on population, including thiazide-type diuretics, calcium channel blockers, ACE inhibitors, and ARBs.
JNC VIII GUIDELINES FOR MANAGEMENT OF BLOOD PRESSURE 2013Praveen Nagula
This document summarizes the 2014 evidence-based guidelines for managing high blood pressure from the JNC 8 panel. The guidelines make 9 recommendations regarding treatment thresholds, goals, and medication selection based on rigorous evidence from randomized controlled trials. The recommendations address treatment for adults aged 60 and older, those under 60, those with chronic kidney disease or diabetes, and the general black population. Initial treatment should include a thiazide diuretic, calcium channel blocker, ACE inhibitor, or ARB based on trial evidence demonstrating the efficacy of these drug classes in lowering blood pressure and reducing cardiovascular events.
This document discusses guidelines for the treatment of hypertension from multiple organizations and studies. It provides recommendations for treatment thresholds, goals, and initial drug choices. For the case patient, a 58-year-old African American woman with diabetes and dyslipidemia, the guidelines recommend a goal blood pressure of <140/90 mmHg and initial drug treatment with a thiazide diuretic or calcium channel blocker. Lifestyle modifications including dietary changes, exercise, weight control, and limiting alcohol and salt are also emphasized.
The document summarizes guidelines from JNC 8 (2014) on the management of hypertension. It provides 3 key recommendations from JNC 8:
1) Treatment should begin for general population aged ≥60 years with SBP ≥150 mmHg or DBP ≥90 mmHg, and for those <60 years with SBP ≥140 mmHg or DBP ≥90 mmHg.
2) The treatment goal for non-diabetic, non-CKD patients is SBP <150 mmHg and DBP <90 mmHg. Lower goals may apply if no adverse effects.
3) Initial treatment should include ACE inhibitors, angiotensin receptor blockers, calcium channel blockers or thiaz
New 2017 aha acc hypertension guidelinesgisa_legal
The new Hypertension Guideline lowers the threshold for diagnosing hypertension from 140/90 mm Hg to 130/80 mm Hg. This means nearly half of American adults now have hypertension based on the new definition. The guideline provides new treatment recommendations including lifestyle changes and BP-lowering medications. It also emphasizes accurate BP measurement and self-monitoring by patients at home.
Challenge in management of hypertensionSolidaSakhan
1. The document discusses challenges in managing hypertension and compares blood pressure targets from different clinical practice guidelines.
2. It outlines methods for accurately measuring blood pressure, including office, home, and ambulatory blood pressure monitoring to diagnose conditions like white coat and masked hypertension.
3. Guidelines discussed recommend targeting a systolic blood pressure of 130 mmHg or lower, though the optimal level remains debated, as lower targets must be balanced with potential adverse effects from treatment. Lifestyle modifications and medication are important for managing hypertension.
This document summarizes recommendations from experts appointed to the Eighth Joint National Committee (JNC 8) on evidence-based management of high blood pressure in adults. Key recommendations include: 1) initiating pharmacologic treatment for those aged ≥60 years with BP ≥150/90 mmHg, treating to <150/90 mmHg; 2) initial treatment includes thiazide diuretics, calcium channel blockers, ACE inhibitors, or ARBs; 3) for those with chronic kidney disease, include an ACE inhibitor or ARB to improve kidney outcomes. The report aims to provide guidance on BP thresholds, goals, and medications based on rigorous review of randomized controlled trial evidence.
The document summarizes guidelines from the International Society of Hypertension (ISH), World Health Organization (WHO), American College of Cardiology/American Heart Association (ACC/AHA), and European Society of Cardiology/European Society of Hypertension (ESC/ESH) on the diagnosis and treatment of hypertension. It compares the guidelines on prevalence of hypertension, treatment thresholds and targets, drug choice and sequencing, and targets for specific patient groups. While the guidelines have some differences, they also have many similarities, including treatment targets of under 140/90 mmHg for most patients and under 130/80 mmHg for high-risk groups.
The document discusses updated guidelines for diagnosing and treating hypertension that were released in 2017. Some key points:
- The new guidelines lower the threshold for stage 1 hypertension to 130/80 mm Hg from 140/90 mm Hg. This means nearly half of US adults now have hypertension based on these guidelines.
- Lifetime risk of developing hypertension is approximately 90% for adults aged 55-65 based on data from the Framingham Heart Study.
- Self-monitoring and ambulatory blood pressure monitoring provide benefits over office-based measurements alone for managing hypertension.
- Lifestyle modifications such as weight loss, reduced sodium intake, increased potassium and physical activity are recommended as first-line treatment for many with elevated blood pressure
This document provides guidance on the management of hypertension. It begins with educational objectives and a case study example. It then reviews the magnitude of hypertension, definitions of true hypertension versus white coat hypertension, and the role of ambulatory blood pressure monitoring. Guidelines for diagnosing and staging hypertension from ACC/AHA and JNC-8 are presented. Non-pharmacologic and pharmacologic treatment options are discussed, including diuretics, ACE inhibitors, ARBs, beta blockers, calcium channel blockers, and vasodilators. Resistant hypertension, hypertensive crises, and hypertension management in specific clinical contexts like stroke are also addressed. Recommendations are provided for evaluating and managing different patient cases.
1) The document compares the 2017 guidelines for hypertension from Hypertension Canada and the American Heart Association/American College of Cardiology.
2) There are some differences in definitions of elevated blood pressure and hypertension thresholds. Hypertension Canada guidelines are more evidence-based while AHA/ACC guidelines are more pragmatic.
3) Both emphasize accurate blood pressure measurement and recommend similar non-pharmacological interventions like weight loss, diet changes, and increased physical activity. However, they differ on when to initiate drug therapy and targets for specific patient groups.
The panel recommends the following for treatment of hypertension in adults:
- For those aged 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For those aged 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For those younger than 60 years with diabetes or chronic kidney disease, treat to a blood pressure goal of less than 140/90 mm Hg.
- Initiate treatment with one of four classes of antihypertensive drugs (angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic). The most appropriate first
The panel recommends the following for treatment of hypertension in adults:
- For those aged 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For those aged 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For those younger than 60 years with diabetes or chronic kidney disease, treat to a blood pressure goal of less than 140/90 mm Hg.
- Initiate treatment with one of four classes of antihypertensive drugs (angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic).
- For non
Eighth Joint National Committee (JNC 8) - Blood Pressure in AdultsSandru Acevedo MD
The panel recommends the following for treatment of hypertension in adults:
- For patients aged 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For patients aged 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For nonblack patients, including those with diabetes, initially treat with a thiazide-type diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker.
- For black patients, including those with diabetes, initially treat with a calcium channel blocker or thiazide-type diuretic.
Jnc 8 guidelines for management of high blood pressure: Lets compare with JNC 7Dr. Afzal Haq Asif
This guideline from the Eighth Joint National Committee provides evidence-based recommendations for the management of high blood pressure in adults. There is strong evidence that treating hypertensive patients aged 60 years or older to a blood pressure goal of less than 150/90 mm Hg and those aged 30-59 years to a goal of less than 90 mm Hg improves health outcomes. For hypertensive patients under age 60, a goal of less than 140/90 mm Hg is recommended based on expert opinion due to insufficient evidence for specific systolic and diastolic goals. The guideline also recommends initiating drug treatment for hypertension with certain classes of medications, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium
The panel recommends the following for treatment of hypertension in adults:
- For ages 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For ages 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For those under 30, or ages 60 or older with diabetes or kidney disease, treat to a goal of less than 140/90 mm Hg.
- Initial drug treatment should include a thiazide-type diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker.
- For nonblack populations, including those with diabetes, consider a
Anemia is a major health problem in India, especially among women. Some key points about anemia from the document include:
- Anemia is defined as a decrease in red blood cells or hemoglobin in the blood. It can be caused by blood loss, impaired red blood cell production, or increased red blood cell destruction.
- The document classifies anemias based on cause (hypo proliferative, hemorrhagic, hemolytic) and cell size (microcytic, normocytic, macrocytic). Common causes discussed are iron deficiency, B12/folate deficiency, aplastic anemia, and hemolytic anemia.
- Signs and symptoms of anemia
This document provides an overview of anemia for nursing students. It defines anemia, discusses its causes and types. It covers the pathophysiology, clinical manifestations, diagnostic evaluation and management of anemia. Nursing management focuses on improving nutrition, managing activity intolerance and improving tissue perfusion. The document aims to help nursing students understand anemia and how to care for patients with this condition.
The document discusses binary logistic regression. Some key points:
- Binary logistic regression predicts the probability of an outcome being 1 or 0 based on predictor variables. It addresses issues with ordinary least squares regression when the dependent variable is binary.
- The logistic regression model transforms the dependent variable using the logit function, ln(p/(1-p)), where p is the probability of an outcome being 1. This results in a linear relationship that can be modeled.
- Interpretation of coefficients is similar to ordinary least squares regression but focuses on odds ratios. A positive coefficient increases the odds of an outcome being 1, while a negative coefficient decreases the odds. The odds ratio indicates how much the odds change with a one-
Hypertension, or high blood pressure, is defined as a systolic blood pressure over 140 mm Hg or a diastolic blood pressure over 90 mm Hg. It has many risk factors including family history, age, gender, obesity, and substance abuse. If left untreated, it can lead to complications like heart attack, stroke, and kidney damage. The document discusses the types of hypertension, diagnostic tests, and medical and nursing management including lifestyle modifications and medications to control blood pressure.
This document summarizes key points about hypertension from Understanding Medical Surgical Nursing, 4th Edition by Linda S. Williams and Paula D. Hopper. It provides statistics on the incidence of hypertension, guidelines for taking blood pressure accurately, classifications of hypertension severity, risk factors, treatment options including lifestyle changes and medications, complications, hypertensive emergencies, and the importance of patient education for lifelong blood pressure control.
Hypertension, or high blood pressure, is defined as a systolic blood pressure over 140 mm Hg or a diastolic blood pressure over 90 mm Hg. It has many risk factors including family history, age, gender, obesity, and substance abuse. If left untreated, it can lead to complications like heart attack, stroke, and kidney damage. Treatment involves lifestyle modifications like diet changes and exercise as well as medication. Nurses educate patients on managing their condition, diet, medication compliance, and monitoring blood pressure at home.
Hypertension is high blood pressure that can lead to severe heart and other health problems if left untreated. It is often asymptomatic until advanced stages. Treatment may involve lifestyle changes like exercise and diet or medications to lower blood pressure. While those with hypertension can usually exercise moderately, untreated hypertension can impair exercise ability. Managing hypertension is important for reducing health risks in older adults.
Coronary angiography is a procedure that uses dye and x-rays to see how blood flows through the coronary arteries of the heart. It is the gold standard for evaluating coronary artery disease and can identify the location and severity of any blockages. A coronary angiogram involves inserting a catheter into the heart and injecting dye so that blockages are highlighted on x-ray images. Potential complications are usually minor but can include heart attack, stroke, or kidney injury from the dye. The results of the angiogram are used to determine if further procedures like angioplasty or bypass surgery are needed.
This document provides information on coronary angiography views and angiographic anatomy. It discusses the clinical divisions of the major coronary arteries and defines what constitutes significant coronary artery disease. Standard angiographic views are described for visualizing different segments of the left and right coronary arteries. Lesion classification systems and other angiogram interpretation elements like TIMI frame count are also summarized.
Coronary angiography remains the gold standard for detecting coronary artery disease. The technique was first performed in 1958 by Dr. Mason Sones at the Cleveland Clinic. Coronary angiography allows visualization of the coronary arteries, branches, and anomalies to precisely locate lesions. It remains an important diagnostic tool used to evaluate patients with suspected coronary artery disease. The procedure involves accessing the femoral artery and advancing a catheter into the heart to inject contrast and obtain images of the coronary arteries under fluoroscopy. Precise technique and monitoring are required to minimize risks of potential complications.
This document discusses vascular access during cardiac catheterization. It covers various topics related to arterial and venous access including common access sites, complications, risk factors, prevention of complications, and management of complications. Specific complications discussed in detail include hematoma, pseudoaneurysm, retroperitoneal hemorrhage. Treatment options for complications like ultrasound-guided compression, thrombin injection, endoluminal techniques are also summarized.
This document discusses congestive heart failure (CHF) and its nutrition management. Myocardial infarction can weaken the heart, limiting its ability to pump blood and removing fluid from the body. This causes a build up of fluid in the extremities and lungs. Nutrition is also impaired as the heart and lungs work harder to pump more fluid. Treatment includes diuretics to reduce fluid load and strengthen the heart. Nutrition therapy aims to reduce cardiac workload by limiting sodium and fluid intake to reduce fluid retention, and providing nutrient-dense foods and supplements if needed to support nutrition and weight status. Close monitoring is needed when providing nutrition support to avoid worsening heart failure.
Heart failure is a common clinical syndrome that can result from any structural or functional impairment of the ventricle that reduces its ability to fill or eject blood. It is the leading cause of hospitalization in adults over 65 years old. The document defines heart failure, discusses its key concepts like cardiac output and ejection fraction, classifications like NYHA and ACC/AHA stages, risk factors, pathophysiology including compensatory mechanisms and remodeling, symptoms, complications, diagnostic tests and emergency management.
This document discusses heart failure and its treatment with drugs. It begins by defining heart failure and listing the objectives of the lecture. It then covers cardiac physiology factors that influence cardiac output like preload, afterload, and contractility. The main drugs used to treat heart failure are also discussed - diuretics, ACE inhibitors, beta-blockers, vasodilators, and digitalis. Side effects and examples of drugs in each class are provided.
This document discusses myocardial infarction (MI), also known as a heart attack. It begins with an introduction defining MI as the death of heart muscle cells from loss of oxygen. It then provides details on the definition, causes, locations, and risk factors of MI. Modifiable risk factors include obesity, diabetes, smoking, and hypertension. The document outlines the pathophysiology of an MI, describing how reduced blood flow leads to cell death. It details the signs and symptoms, diagnostic tests, drug and surgical treatment options, and recent advances in MI management, including optimizing percutaneous coronary intervention outcomes and strategies to reduce reperfusion injury.
This document provides an overview of myocardial infarction (MI), also known as a heart attack. It defines MI as irreversible damage to the heart muscle caused by prolonged lack of oxygenated blood flow. The document outlines the types, epidemiology, causes, pathophysiology and clinical manifestations of MI. It also discusses the diagnostic criteria including cardiac enzymes, electrocardiogram changes and imaging tests. Finally, it summarizes the treatment approach for MI including both non-pharmacological and pharmacological management as well as revascularization procedures like angioplasty, stenting and bypass surgery.
This document discusses the analysis of a 12-lead EKG. It begins by describing the components that should be assessed, including rhythm, rate, axis, and grouped lead analysis. Specific abnormalities are then discussed in detail such as ST segment changes, bundle branch blocks, Q waves, and more. The overall goal is to systematically analyze all aspects of the 12-lead EKG to evaluate for any cardiac abnormalities.
Echocardiography uses ultrasound to generate images of cardiac structure and function and assess blood flow dynamics. Common laboratory tests for cardiovascular patients include complete blood count, electrolytes, renal function, liver function, lipid panel, and biomarkers like BNP and troponins. Modern cardiovascular imaging includes echocardiography, nuclear imaging like PET, cardiac magnetic resonance imaging, and computed tomography which provide information on structure, function, blood flow, and tissue characteristics.
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
1. Monica Mukherjee, MD, MPH, FACC, FASE
Assistant Professor of Medicine
Johns Hopkins University Division of Cardiology
Baltimore, Maryland
JNC 8 Updates on Hypertension
Email: mmukher2@jhmi.edu
3. Introduction
• Hypertension affects 29% US adult population
– Estimated 72 million people, with a prevalence of >65% in persons older
than 60 yrs, 1 in 3 adults
• Hypertension disproportionately affects the African American
community with over 45% AA males and 46% AA females affected
by high blood pressure compared to a national rate of 33%.
• Attributable risk factor in 41% of all CVD deaths from MI, heart
failure, and stroke
• HTN in middle age is known to increase the risk of chronic kidney
disease (CKD) and dementia in later life
6 December 2016 Nwankwo T, et al. Natl Center Health Stat. 2013;133:1–8
Gottesman R, et al. JAMA Neurol. 2014;71:1218–27
4. Introduction
• Graded relationship between increasing BP and risk of
CVD
– Increase in BP 20 mmHg systolic or 10 mmHg diastolic
associated with a doubling of the risk of CVD death, regardless
of age
• Despite increasing BP recognition and improvement in
control are improving, nearly half of the hypertensive
population remains suboptimally controlled
6 December 2016 Lewington S, et al. Lancet. 2002;360:1903–13
5. Many Americans are living with high
blood pressure that is not controlled
5
From 2009 to 2012 among US adults with HBP
Our Goal for
Better Control
AHA 2015 Statistical Update
Slide courtesy of the American Heart Association
6. JNC 8 Recommendations
• JNC7 published in 2003, IOM called for updated
guidelines in 2011 aimed at answering 3 major
questions:
– Does initiating antihypertensive treatment at specific BP
thresholds improve health outcomes?
– Does treatment with antihypertensive therapy to a specific BP
goal improve health outcomes?
– Are there differences in benefit/harm between antihypertensive
drugs or drug classes on specific health outcomes?
6 December 2016 Kovell LC et al. J Am Heart Assoc. 2015;4(12): e002315
James PA et al. JAMA. 2014;311:507–20
7. JNC 8 Recommendation 1
• In the general population ≥ 60 yrs, initiate pharmacologic
treatment at SBP ≥150 mmHg or DBP ≥90 mmHg and treat
to a goal SBP <150 mmHg and DBP <90 mmHg
• JNC 8 BP target of <150/90 mmHg is recommended for
those older than 60 yrs, evidence for this target is strongest
for those >80 yrs
– Hypertension in the Very Elderly Trial: benefit to treating patients
>80 yrs to an average SBP of 144 mmHg
– 39% reduction in fatal strokes, 21% reduction in death from any
cause, and 64% reduction in HF
– Frail adults >80 yrs were excluded from the trial
6 December 2016 Kovell LC et al. J Am Heart Assoc. 2015;4(12): e002315.
Beckett NS et al. N Engl J Med. 2008;359:1887-98
8. JNC 8 Recommendation 1
• SPRINT designed to look for a benefit of intensive BP treatment in
those at risk for developing heart failure or CVD
– Randomized 9361 nondiabetic adults ≥50 yrs with no prior stroke to a standard
group with target SBP <140 mmHg and an intensive group with target SBP
<120 mmHg
– Average age of 68 yrs and Framingham 10-year CVD risk 20%
• Significantly reduced relative rates of CVD-related death
(43%, p=0.005) and events (25%, P<0.001)
• Reduction in CVD events came at the cost of higher rates of
hypotension, acute kidney injury, syncope, and electrolyte
disturbances
• Results from SPRINT contradict the recommendations of JNC8 and
may support even lower SBP targets for the consideration of the new
AHA/ACC guideline committee
6 December 2016 Ambrosius WT et al. Clin Trials. 2014;11:532–546
9. JNC 8 Recommendation 2
• In all persons <60 yrs or >18 yrs (and either those
younger or older than 60 yrs with either DM or CKD),
initiate pharmacologic treatment to lower SBP ≥140 or
DBP ≥90 mmHg and treat to a goal BP of
<140/90 mmHg
• Recommendation for target BP in DM by most
professional societies is <140/90 mmHg, although
ESH/ESC recommend a DBP target of <85 mmHg
– More support can be found for DBP versus SBP goals among
younger adults with HTN and DM
6 December 2016 Kovell LC et al. J Am Heart Assoc. 2015;4(12): e002315.
Hansson L et a. Lancet 2008;351:1755–1762
11. Guidelines for Referral
Visit and Clinical Status Blood Pressure Recommendations
Hypertensive urgency or emergency ≧ 210 and/or
≧120 mmHg
1. Recheck BP after 5 minutes
2. Abort any planned procedure, call 911
3. Provide referral note with details of BP
Single-visit dental hygienist’s
reading for a patient/client with a
history of risk factors (prior MI,
angina, recurrent stroke, DM, renal
disease)
180-209 and/or
110/119 mmHg
1. Recheck BP after 5 minutes
2. Abort any planned procedure, call 911
3. Provide referral note with details of BP
4. Refer the patient/client for a medical
consultation
Single-visit dental hygienist’s
reading for a patient/client with a
history of risk factors (prior MI,
angina, recurrent stroke, DM, renal
disease)
1. Re-check BP after 5 minutes
2. Perform only non-invasive dental
hygiene care; avoid invasive
procedures
3. Give the patient/client a written note of
all the BP readings
4. Refer the patient/client for a medical
consultation
6 December 2016 Adapted from: Zahedi S. Oral Health 2012-02-01.
12. Guidelines for Referral
Visit and Clinical Status Blood Pressure Recommendations
Single-visit dental hygienist’s reading
for a patient/client with a history of
risk factors (prior MI, angina,
recurrent stroke, DM, renal disease)
160-179 and/or
100-109 mmHg
1. Recheck BP after 5 minutes
2. Perform only non-invasive dental
hygiene care; avoid invasive
procedures
3. Give the patient/client a written note of
all the BP readings
4. Refer the patient/client for a medical
consultation
Single-visit dental hygienist’s reading
for a patient/client with a history of
risk factors (prior MI, angina,
recurrent stroke, DM, renal disease)
130-159 and/or
80-99 mmHg
1. Re-check BP after 5 minutes
2. Perform only non-invasive dental
hygiene care; avoid invasive
procedures
3. Give the patient/client a written note of
all the BP readings
4. Refer the patient/client for a medical
consultation
6 December 2016 Adapted from: Zahedi S. Oral Health 2012-02-01.
13. Guidelines for Referral
Visit and Clinical Status Blood Pressure Recommendations
Single-visit dental hygienist’s reading
for a patient/client with a history of
risk factors (prior MI, angina,
recurrent stroke, DM, renal disease)
or who is receiving anti-hypertensive
medication
<130 and/or 80
mmHg
1. Proceed with dental hygiene care and
procedures as required
6 December 2016 Adapted from: Zahedi S. Oral Health 2012-02-01.
14. Blood Pressure Management
American Heart Association Programs
AHA is working toward that goal here in Maryland by
encouraging participation in these two blood pressure
management programs.
Target: BP
§ AHA/AMA call to action
§ Clinical resources for improving HBP
§ Recognition
Check. Change. Control.®
§ Individual self-management program
§ Offered through key partners
14
Slide courtesy of the American Heart Association
15. Blood Pressure Management
What is Target: BP?
15
A call to action motivating medical practices,
practitioners and health services organizations to
prioritize blood pressure control
Recognition for healthcare providers who attain high
levels of blood pressure control in their patient
populations, particularly those who achieve 70, 80
percent or higher control
A source for tools and assets for healthcare providers
to use in practice, including the AHA/ACC/CDC
Hypertension Treatment Algorithm and the AMA’s
M.A.P. Checklist
ü
ü
ü
Slide courtesy of the American Heart Association
16. Blood Pressure Management
What is Check. Change. Control.®?
16
Developed to support hypertension management among
the adult population, Check. Change. Control.® engages
participants, emphasizing 3 important aspects of
managing hypertension:
1.Checking for high blood pressure and symptoms;
2.Changing lifestyle and seeking treatment;
3.Controlling hypertension by taking preventative
measures.
Slide courtesy of the American Heart Association
17. Additional Resources
AHA Go Red for Women Campaign
https://www.goredforwomen.org
Johns Hopkins Women's Cardiovascular Health Center
Monica Mukherjee, MD, MPH, mmukher2@jhmi.edu
American Heart Association, Maryland
Danelle Buchman, Senior Community Health Director, danelle.buchman@heart.org
17
19. Special Consideration: Diabetes
• Action to Control Cardiovascular Risk in Diabetes
(ACCORD) trial compared 2 SBP targets in diabetic
patients, <140 or <120 mmHg
– 4.7 yrs follow-up, the primary outcome of nonfatal MI, stroke, or
CVD death was not significantly different between the 2 groups
– Total stroke rate in intensive arm was reduced by 41% (p=0.01)
• Based on these studies, achieving a lower BP goal in
people with diabetes appears to be more consistently
associated with a lower risk of stroke than MI
– Support a target SBP <140 mmHg and DBP <85 mmHg in DM
6 December 2016 ACCORD Study Group. N Engl J Med. 2010;362:1575–85.
20. Special Consideration: Diabetes
• Action to Control Cardiovascular Risk in Diabetes
(ACCORD) trial compared 2 SBP targets in diabetic
patients, <140 or <120 mmHg
– 4.7 yrs follow-up, the primary outcome of nonfatal MI, stroke, or
CVD death was not significantly different between the 2 groups
– Total stroke rate in intensive arm was reduced by 41% (p=0.01)
• Based on these studies, achieving a lower BP goal in
people with diabetes appears to be more consistently
associated with a lower risk of stroke than MI
– Support a target SBP <140 mmHg and DBP <85 mmHg in DM
6 December 2016 ACCORD Study Group. N Engl J Med. 2010;362:1575–85.
21. Special Consideration: CKD
• BP targets in CKD were also increased from <130/80 to
<140/90 mmHg between the JNC 7 à JNC 8
• Important distinction between CKD based on proteinuria
status, with a lower BP goal of <130/80 to 90 mmHg for
those with proteinuria detectable on urinanalysis
• Given that the baseline risk of the patient appears to
influence the outcomes of BP treatment, a lower BP goal
of <130/80 mmHg may be recommended for those with
>300 mg/d proteinuria
6 December 2016 Flack JM. Hypertension 2010;56:780-800.
Weber MA. J Hypertens. 2014;32:3–15.
22. Special Consideration:
Secondary Prevention of CVD
• AHA, ACC, ASH, ESC endorse a goal of
<140/90 mmHg for those with HTN and CVD with an
optional target of <130/80 mmHg for those with CVD
and previous MI, stroke/TIA, carotid artery disease,
peripheral arterial disease, or abdominal aortic
aneurysm
6 December 2016 Rosendorff C. Circulation 2007;115:2761-88.
23. JNC 8 Recommendation 6-9
• In the general nonblack population, including those with DM,
initial antihypertensive treatment should include a
thiazide-type diuretic, CCB, ACEI, or ARB
• In the general black population, including those with
diabetes, initial antihypertensive treatment should include a
thiazide-type diuretic or CCB
– In the black population with HTN (no DM or CKD), CCBs and
thiazide diuretics generally tend to be favored as initial therapy
over renin-angiotensin system blockers based on subgroup
analysis from ALLHAT
– If a black patient has coexisting CKD and albuminuria, initial
treatment should be an ACEI or ARB
6 December 2016 James PA et al. JAMA. 2014;311:507–20
ALLHAT Investigators. JAMA. 2002;288:2981–97
24. JNC 8 Recommendation 6-9
• In the population aged ≥18 yrs with CKD, initial (or
add-on) antihypertensive treatment should include an
ACEI or ARB to improve kidney outcomes
– Baseline risk and degree of proteinuria important in guiding
intensiveness of antihypertensive therapies
• While JNC 8 has the same treatment recommendations
for people with or without diabetes, most other societies
suggest that only ACEIs or ARBs should be first-line
treatment for patients with diabetes
6 December 2016 Kovell LC et al. J Am Heart Assoc. 2015;4(12): e002315
James PA et al. JAMA. 2014;311:507–20