Hypertensive Guidelines

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Presentation transcript:

Hypertensive Guidelines Thomas Haffey, D.O., FACC,FAHA FACOI, FNLA

Disclosures Speaker bureau: Merck Research: Merck GSK

Clinical Case F.R

Structure of Committee JNC 8 Sept 2008 17 physicians 2 hour interview with Eduardo Ortiz, MD, MPH (NHBLI physician who choose the panel)

Questions 23 original questions from physicians who manage high blood pressure Derived from primary care, nurse practioners and physicians assistants

Questions to the JNC 8 panel 1. What level should you treat blood pressure? 2. To what level should it be treated? 3. How do you accomplish that ?

Difference between JNC7 and JNC8 Shorter time frame(3-4) More involvement Wider use of data base Consensus vs Evidence based

Patient Populations Age Diabetic Black/nonblack Chronic kidney disease

AGE <18 y/o not considered <30 y/o little or no data

AGE 30-59 y/o Diagnose DBP > 90 mmHg Treat < 90 mmHg Evidence: Grade A

AGE 60 to 79 y/o Treat SBP<150; DBP < 90 mmHg Evidence: grade A

AGE 80 y/o based on HYVET

Diabetes 18 years or older with diabetes Initiate therapy to lower SBP at 140 and DBP of90 Goals: SBP<140 ; DBP <90 Evidence level=E (Expert opinion)

CKD Population >18 years old with CKD Initiate therapy SBP >140 DBP >90 Treatment Target: SBP <140 DBP<90 Level of Evidence: Grade E

JNC-7vs JNC-8 Effort to derive conclusions based on: “What does the evidence show ? (as much as we have it) Recommendations- What should I do?

NHLBI stated Goal “Develop a guideline based on evidence”

“No refills”

AHA Guidelines Built on 11% Level A evidence

Purpose Develop a guideline that is based on evidence Used practically in the clinic Identify what is not present in the data base Deliver a document to the NHLBI

Nonblack Patients Initiate Therapy Thiazide-type diuretic Calcium Channel blocker Angiotensin-converting enzyme(ACE) inhibitor Angiotensin receptor blocker (ARB) Level of Evidence : Grade B

Black Patients Thiazide-type diuretic CCB Level of Evidence: General Black population: Grade B Blacks (with Diabetes): Grade C (weak)

ADHERENCE Side effects Simplicity Initial Conversation? Role as an educator The role of the patient- ?ambulatory BP monitors

Lord, keep Your arm around my shoulder and Your hand over my mouth

There was a moment of silence before the senior lady replied, "I'm wondering, then, just how serious is my condition because this prescription is marked 'NO REFILLS'.."

GETTING OLDER A distraught senior citizen phoned her doctor's office. "Is it true," she wanted to know, "that the medication you prescribed has to be taken for the rest of my life?"

GETTING OLDER "'Yes, I'm afraid so,"' the doctor told her.