Whats all the controversy about 2015 Kevin M Hayes DO FACC Disclosures Nothing to disclose Hypertension guidelines Thanks for clearing that up for me NOT Really Objectives Brief review of pathophysiology ID: 556522
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Hypertension guidelines What’s all the controversy about 2015
Kevin M Hayes D.O. FACCSlide2
DisclosuresNothing to discloseSlide3
Hypertension guidelinesThanks for clearing that up for me – NOT ReallySlide4
ObjectivesBrief review of pathophysiology
Scope of the problem
JNC – 8
ACC / AHA
“End of the day”Slide5Slide6
HTN leads to an increased risk of death from stroke and heart disease
Systolic BP / Diastolic BP (mmHg)
8x
4x
2x
CV mortality risk doubles for every 20 mmHg increase in systolic blood pressure.
1,2
Cardiovascular Mortality Risk
Chobanian
et al. Hypertension 2003;42:1206-1252;
2
Lancet 2002;360:1903-1913Slide7
Prevalence of risk factors – Western population ( Framingham) Hypertension – 20 %> 65
y.o
. 65 %
Smoking 31%
Overweight 54%
Hyperlipidemia 55%Slide8
Problem MagnitudeHypertension( HTN) is the most common
primary diagnosis in America.
35 million office visits are as the primary diagnosis of HTN.
50 million or more Americans have high BP.
Worldwide prevalence estimates for HTN may be as much as 1 billion.
7.1 million deaths per year may be attributable to hypertension.Slide9
Figure 10. Stroke mortality rate in each decade of age versus usual blood pressure at the start of that decade.
Aram V. Chobanian et al. Hypertension. 2003;42:1206-1252
Copyright © American Heart Association, Inc. All rights reserved.Slide10Slide11
Types of Hypertension Primary HTN:
also known as essential HTN.
accounts for 95% cases of HTN.
no universally established cause known.
Secondary HTN
:
less common cause of HTN ( 5%).
secondary to other potentially rectifiable causes.Slide12
Identifiable Causes of HTNSleep apnea
Drug-induced or related causes
Chronic kidney disease
Primary
aldosteronism
Renovascular
disease
Chronic steroid therapy and Cushing’s syndrome
Pheochromocytoma
Coarctation
of the aorta
Thyroid or parathyroid diseaseSlide13
Aram V. Chobanian et al. Hypertension. 2003;42:1206-1252
Copyright © American Heart Association, Inc. All rights reserved.Slide14
JNC – 8 Expert writing group Slide15
In patients 60 years or over, start treatment in blood pressures >150 mm Hg systolic or >
90 mm Hg diastolic and treat to under those thresholds
.
In patients <60 years, treatment initiation and goals should be 140/90 mm Hg, the same threshold used in patients
>
18 years with either chronic kidney disease (CKD) or diabetes.
In nonblack patients with hypertension, initial treatment can be a thiazide-type diuretic, CCB, ACE inhibitor, or ARB, while in the general black population, initial therapy should be a thiazide-type diuretic or CCB.
In patients
>
18 years with CKD, initial or add-on therapy should be an ACE inhibitor or ARB, regardless of race or diabetes status.Slide16
JNC 8 is mostly in line with the European Society of Hypertension (ESH) guidelines released earlier this year, which suggested a target of <140 mm Hg systolic BP for "all" patients, with some caveats
In patients with diabetes, the ESH guidelines suggest a diastolic BP of <85 mm Hg, and for patients under 80 years, they suggest a target of between 140 and 150, going lower only if the patient is fit and in good healthSlide17
Date of download: 4/23/2015
Copyright © 2015 American Medical Association. All rights reserved.
JAMA. 2014;311(5):507-520. doi:10.1001/jama.2013.284427Slide18Slide19
Treatment of Hypertension in Patients With CoronaryArtery DiseaseA Scientific Statement From the American Heart Association,American College of Cardiology, and American
Society of Hypertension
Circulation – May 2015Slide20
We felt the best evidence [to prevent future cardiovascular events] was to reduce pressure below 140/90 mm Hg, but a goal pressure of less than 130/80 mm Hg may be appropriate in some cases; we left it to the discretion of physicians to decide which blood pressure target to choose,”Slide21
ACC/AHA 2015CAD PATIENTS - >80 Y.O. – LESS THAN 150/90Slide22
Hypertension guidelinesNow I’m really confusedSlide23
Any ?