Fsdfs

Hypertension

Courtney L. Meuth, PharmD, BCPS

January 29, 2015

clmeuth@mdanderson.org

Objectives

 Review epidemiology and pathophysiology of hypertension

 Summarize JNC VII and VIII guidelines for HTN

 Review the different classes of antihypertensive medications

 Patient Cases

Required Readings

 JNC 7 Guidelines

 Chobanian AV et al. The Seventh Report of the Joint National Committee on

Prevention, Detection, Evaluation, and Treatment of High Blood PressureThe JNC 7

Report. JAMA. 2003;289(19):2560-2571.

 JNC 8 Guidelines

 James PA et al. 2014 Evidence-Based Guideline for the Management of High Blood

Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint

National Committee (JNC 8). JAMA. 2013 Dec 18. doi:

10.1001/jama.2013.284427.

Supplemental Readings

 ASH paper

 Weber, MA. Clinical practice guidelines for the management of hypertension in the

community a statement by the american society of hypertension and the international

society of hypertension. J Clin Hypertens (Greenwich). 2013 Dec 17. doi:

10.1111/jch.12237

 ESH/ESC Guidelines

 Mancia G et al. 2013 ESH/ESC Practice Guidelines for the Management of Arterial

Hypertension. Blood Press. 2013 Dec 20.

Epidemiology

 67 million American adults (31%) have HTN

 69% of people who have a first MI, 77% of people with a

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first stroke, and 74% of people with HF have HTN

HTN is also a major risk factor for kidney disease

>348,000 deaths in 2009 included HTN as a primary cause

$47.5 billion annually in direct medical expenses

Only 47% of people with HTN under control

http://www.cdc.gov/bloodpressure/facts.htm

Epidemiology

 There is a close relationship between blood pressure levels

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and the risk of CV events, stroke, and kidney disease

The risk of CVD begins at 115/75 mmHg doubles with each

increment increase of 20mmHg SBP or 10 mmHg DBP

In persons older than 50 years, SBP is a much more...