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Hypertension Guidelines 2014 Jason A. Smith, DO Associated Cardiovascular Consultants at Lourdes Cardiology Services Disclosures No disclosures Hypertension • Hypertension is the most common condition in primary care. • 1 in 3 patients have hypertension according to NHLBI • Risk factor for MI, CVA, ARF, death Hypertension Case • A 58 year old African-American woman with diabetes and dyslipidemia has a BP of 158/94 confirmed on several office visits. Other than obesity, the exam is normal. Labs show normal renal function, well-controlled lipids on atorvastatin and well-controlled diabetes on metformin. Urine micro- albumin is mildly elevated. Case Question 1 • What goal BP is most appropriate for this patient? 1. <150/90 mmHg 2. <130/80 mmHg 3. <140/90 mmHg 4. <140/80 mmHg 5. <140/85 mmHg Case Question 2 • What is the drug of choice to start? 1. HCTZ 2. Norvasc 3. Lisinopril 4. Losartan 5. Bystolic 6. Combination therapy Classification of BP – JNC 7 Category Systolic (mmHg) Diastolic (mmHg) Normal < 120 and < 80 Pre-HTN 120-139 or 80-89 Hypertension Stage I 140-159 or 90-99 Stage II > 160 or > 100 Medical Education & Information – for all Media, all Disciplines, from all over the World Powered by 2013 ESH/ESC Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357 Definitions and classification of office BP levels (mmHg)* Category Systolic Diastolic Optimal <120 and <80 Normal 120–129 and/or 80–84 High normal 130–139 and/or 85–89 Grade 1 hypertension 140–159 and/or 90–99 Grade 2 hypertension 160–179 and/or 100–109 Grade 3 hypertension ≥180 and/or ≥110 Isolated systolic hypertension ≥140 and <90 * The blood pressure (BP) category is defined by the highest level of BP, whether systolic or diastolic. Isolated systolic hypertension should be graded 1, 2, or 3 according to systolic BP values in the ranges indicated. Hypertension: SBP >140 mmHg ± DBP >90 mmHg JNC 8 • 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults – JAMA. 2014;311(5):507-520 – December 18, 2013 [...]... Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357 Medical Education & Information – for all Media, all Disciplines, from all over the World Powered by BP goal in the elderly 2013 ESH/ESC Guidelines for the management of arterial hypertension Hypertension treatment for people... The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357 Medical Education & Information – for all Media, all Disciplines, from all over the World Powered by 2013 ESH/ESC Guidelines for the management of arterial hypertension Hypertension treatment for people with nephropathy... Pressure Control: A Science Advisory From the AHA, ACC, and CDC • Hypertension online November 15, 2013 • Clinical Practice Guidelines for the Management of HTN in the Community A Statements by the ASH/ISH • J Hypertension 2014; 32:3-15 2013 ESH/ESC Guidelines for the management of arterial hypertension Blood pressure goals in hypertensive patients Recommendations SBP goal for “most” •Patients at low–moderate... Intern Med January 14, 2014 • 5/17 authors (29%) • “Insufficient evidence” to increase target SBP to 150 mmHg • Expertise vs Scientific Evidence Recent HTN Guideline Statements • 2013 ESH/ESC Guidelines for the management of arterial hypertension • J Hypertnsion 2013;31:1281-1357 • An Effective Approach to High Blood Pressure Control: A Science Advisory From the AHA, ACC, and CDC • Hypertension online... CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; RAS, renin–angiotensin system The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357 Medical Education & Information – for all Media, all Disciplines, from all over the World Powered by What is the goal... 5-7 days/week (moderate, dynamic exercise) Quit smoking * Unless contraindicated BMI, body mass index The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357 Medical Education & Information – for all Media, all Disciplines, from all over the World Powered by Thank you for... ≥140 mmHg SBP goals for patients with diabetes: 1 year – Reported effect of treatment on important health outcomes (mortality, MI, HF, CVA, ESRD) • January 1966 to December 2009 – Separate criteria used of RCT’s published after December 2009 JNC 8: Hypertension Management Evidence Review...JNC 8: Hypertension Management Questions Guiding Review • In adults with HTN: 1 Does initiating antihypertensive pharmacologic therapy at specific BP thresholds improve health outcomes? 2 Does treatment with . Hypertension Guidelines 2014 Jason A. Smith, DO Associated Cardiovascular Consultants at Lourdes Cardiology Services Disclosures No disclosures Hypertension • Hypertension is. of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension. 130–139 and/or 85–89 Grade 1 hypertension 140–159 and/or 90–99 Grade 2 hypertension 160–179 and/or 100–109 Grade 3 hypertension ≥180 and/or ≥110 Isolated systolic hypertension ≥140 and <90 *
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