The Hypertension Treatment Center

Size: px
Start display at page:

Download "The Hypertension Treatment Center"

Transcription

1 Patricia F. Kao MD MS Asst Professor, EVMS Nephrology & HTN April 26, 2014 The Hypertension Treatment Center

2 I have no conflicts of interest to disclose

3 Objectives Describe the role of Hypertension Treatment Centers Review the initial approach and evaluation of the complex hypertensive patient Discuss the definition and diagnosis of different patterns of blood pressure Discuss future options in the management patients with refractory hypertension

4 Hypertension Treatment Centers Multidisciplinary team of highly trained nurses, social workers, dieticians, hypertension specialists (internal medicine, nephrology, cardiology) Patients often referred for second opinions regarding refractory HTN cases Can provide ongoing management of blood pressure in difficult cases

5 Hypertension Treatment Centers Goals are to: Establish the correct diagnosis Optimize therapy Provide extensive patient education

6 Hypertension Treatment Centers Initial evaluation will include: Detailed history and physical exam, including dietary salt intake, lifestyle patterns, and social and psychosocial stressors Ophthalmologic assessment and funduscopic exam performed to identify severity Presenter of disease name and target organ damage by grading retinal changes

7 Standard BP measurement Taken after 5 min in a quiet room Patient seated comfortably with back supported Upper arm bared without constrictive clothing Legs should not be crossed Arm should be supported at the level of the heart Bladder of the BP cuff should encircle at least 80% of the arm circumference BP device should be deflated at a rate of 2-3 mm/sec No talking during the measurement

8 Establishing the Correct Diagnosis 24 hr urine studies for: Na (helps evaluate dietary salt intake and also makes sure salt intake is adequate enough to evaluate aldo levels properly when needed) Aldosterone when indicated (hx of hypokalemia or inconclusive plasma renin and Presenter aldo) name Metanephrines when indicated (hx of flushing, diaphoresis, episodic or fluctuating BP)

9 Other Causes of Secondary Renal Artery Stenosis Hypertension Several large studies (CORAL and ASTRAL) have failed to show a clear benefit to renal artery stenting. I only recommend w/u in high risk pts: Hx of flash pulmonary edema Unexplained rapid worsening of renal function Uncontrolled HTN on maximal medical therapy (5 or more meds)

10 Once potentially treatable secondary causes are ruled out, the next step is to characterize the BP pattern

11 Ambulatory Blood Pressure Monitoring (ABPM) 24 hr monitoring of blood pressure Useful for diagnosis of: White coat hypertension Apparent drug resistance Nocturnal hypertension Masked hypertension Non-dipper status

12 ABPM Also helpful in: better defining resistant HTN Identifying hypotensive symptoms while the patient is being treated with anti-hypertensive meds Identifying autonomic dysfunction states Monitoring episodic hypertension

13

14

15

16

17 Masked Hypertension Defined as normal office BP and elevated home BP Prevalence ranges from 8% in the general population to as much as 20% in hypertensive patients receiving treatment

18 Masked Hypertension May be caused by reactivity to daily life stressors and behavioral factors such as smoking, alcohol use, contraceptive use in women, and sedentary habits High risk populations are patients Presenter with name CKD or Diabetes Mellitus

19 Masked Hypertension No large outcomes studies of this condition, however the CV risk profile has been reported to be similar to that of sustained HTN Associated with increased risks of: metabolic risk factors left ventricular mass index carotid intima-media thickness impaired large artery distensibility

20 Target organ damage and masked hypertension in the general population: the Finn-Home study. Hanninen, Marjo-Riitta; Niiranen, Teemu; Puukka, Pauli; Kesaniemi, Yrjo; Kahonen, Mika; Jula, Antti; Journal of Hypertension. 31(6): , June DOI: /HJH.0b013e32835fa5dc

21 White Coat Hypertension (WCH) Defined as having an elevated office BP and normal home BP measurements Prevalence is 12-18% in the general population Originally thought to be a benign condition, however, Verdecchia et al published Presenter a study name of 4406 subjects in 2005 suggesting that WCH is an independent risk factor for CVA

22

23 Verdecchia et al., Hypertension 2005;45(2):

24 Non-Dipping Normal diurnal variation in BP should have a 10-20% decrease in sys BP during sleep, referred to as dipping. This was first described by O Brien et al. in 1998 in the Lancet. Non-Dipping has been associated with worse CV outcomes, even in subjects who are normotensive

25 Non-Dipping Verdecchia et al. published a study in Hypertension, 1998, looking at CV outcomes in non-dippers CV events included MI, CVA, sudden death, angina pectoris, coronary revascularization, TIA, aortoiliac occlusive disease, thrombotic occlusion of a retinal artery, and progressive cardiac or renal failure

26

27

28 Nocturnal Hypertension BP measured during sleep is higher than that measured when the patient is awake A risk factor for increased CV disease The AASK trial reported an abnormal dipping pattern in 80% of patients, and Presenter nocturnal name HTN found in 40%. All of these patients had HTN that was well-controlled based on office BP readings.

29 Ambulatory Blood Pressure Monitoring CMS will only reimburse for ABPM use in suspected white coat HTN Several task forces have advocated more wide spread use and access to ABPM Crucial in distinguishing different Presenter patterns name of BP

30 Ambulatory Blood Pressure Monitoring BP patterns is crucial for guiding which BP readings to use for titrating meds (AM or PM readings, exclusively home readings) Once we have categorized a patient s BP pattern, can also tailor the timing of meds appropriately

31 Morning or Evening Dosage Several studies have looked at bedtime dosing of calcium channel blockers and ARB s to restore nocturnal dipping status.

32 Currently a study being conducted at the University of Iowa and at Duke University, randomizing patients to either continue morning dosing of all antihypertensive agents or to switch their nondiuretic medications to bedtime dosing. Patients will be followed for 36 to 42 months. Study will examine whether QHS dosing reduces CV risk compared with traditional AM dosing of antihypertensive meds.

33 What else is on the horizon? The Symplicity renal denervation system has received much attention Involves a catheter passed through femoral access that performs radiofrequency ablation to the lumen of the renal arteries

34 Renal Denervation SYMPLICITY HTN -1 and SYMPLICITY HTN -2 trials showed significant lowering of BP in patients with resistant HTN. However, these were unblinded studies

35 Renal Denervation Symplicity HTN-3 was recently published in the New England Journal of Medicine this month Prospective, single-blind, randomized, shamcontrolled trial of 535 patients Results did not show a significant reduction sys BP at 6 months

36

37

38 Renal Denervation Although the results of SYMPLICITY HTN-3, the authors will cont to follow the subjects for up to 5 yrs to determine if the 6 month end point was too short Also no way to confirm that the Symplicity catheter system successfully denervated the renal nerves. Different methods of renal denervation may need to be investigated in future trials

39 THANK YOU!

Renovascular Hypertension

Renovascular Hypertension Renovascular Hypertension Philip Stockwell, MD Assistant Professor of Medicine (Clinical) Warren Alpert School of Medicine Cardiology for the Primary Care Provider September 28, 201 Renovascular Hypertension

More information

ADULT HYPERTENSION PROTOCOL STANFORD COORDINATED CARE

ADULT HYPERTENSION PROTOCOL STANFORD COORDINATED CARE I. PURPOSE To establish guidelines for the monitoring of antihypertensive therapy in adult patients and to define the roles and responsibilities of the collaborating clinical pharmacist and pharmacy resident.

More information

CONGESTIVE HEART FAILURE PATIENT TEACHING

CONGESTIVE HEART FAILURE PATIENT TEACHING CONGESTIVE HEART FAILURE PATIENT TEACHING What is Heart Failure? Congestive Heart Failure occurs when the heart loses its ability to pump enough blood to meet the body s needs. Because the heart is not

More information

Cardiovascular Risk in Diabetes

Cardiovascular Risk in Diabetes Cardiovascular Risk in Diabetes Lipids Hypercholesterolaemia is an important reversible risk factor for cardiovascular disease and should be tackled aggressively in all diabetic patients. In Type 1 patients,

More information

Metabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007

Metabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Metabolic Syndrome Overview: Easy Living, Bitter Harvest Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Evolution of Metabolic Syndrome 1923: Kylin describes clustering

More information

Blood Pressure Assessment Program Screening Guidelines

Blood Pressure Assessment Program Screening Guidelines Blood Pressure Assessment Program Screening Guidelines Assessment Pre-Assessment Prior to/during assessment, explain to client the following: What is meant by high blood pressure; What are the effects

More information

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South Medical management of CHF: A New Class of Medication Al Timothy, M.D. Cardiovascular Institute of the South Disclosures Speakers Bureau for Amgen Background Chronic systolic congestive heart failure remains

More information

Blood Pressure. Blood Pressure (mm Hg) pressure exerted by blood against arterial walls. Blood Pressure. Blood Pressure

Blood Pressure. Blood Pressure (mm Hg) pressure exerted by blood against arterial walls. Blood Pressure. Blood Pressure Blood Pressure Blood Pressure (mm Hg) pressure exerted by blood against arterial walls Systolic pressure exerted on arteries during systole Diastolic pressure in arteries during diastole 120/80 Borderline

More information

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with

More information

Listen to your heart: Good Cardiovascular Health for Life

Listen to your heart: Good Cardiovascular Health for Life Listen to your heart: Good Cardiovascular Health for Life Luis R. Castellanos MD, MPH Assistant Clinical Professor of Medicine University of California San Diego School of Medicine Sulpizio Family Cardiovascular

More information

Main Effect of Screening for Coronary Artery Disease Using CT

Main Effect of Screening for Coronary Artery Disease Using CT Main Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High risk Patients with Diabetes: The FACTOR-64 Randomized Clinical Trial Joseph B. Muhlestein,

More information

Hypertension Guidelines

Hypertension Guidelines Overview Hypertension Guidelines Aim to reduce Blood Pressure to 140/90 or less (140/80 for diabetics), adding drugs as needed until further treatment is inappropriate or declined. N.B. patients do not

More information

Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria.

Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria. Kidney Complications Diabetic Nephropathy Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria. The peak incidence of nephropathy is usually 15-25 years

More information

Atrial Fibrillation An update on diagnosis and management

Atrial Fibrillation An update on diagnosis and management Dr Arvind Vasudeva Consultant Cardiologist Atrial Fibrillation An update on diagnosis and management Atrial fibrillation (AF) remains the commonest disturbance of cardiac rhythm seen in clinical practice.

More information

Hypertension Guideline V4

Hypertension Guideline V4 Hypertension Guideline V4 Approved 24/06/2008 Version VERSION 4 FINAL Date of First Issue 26/02/08 Review Date 01/03/2010 Date of Issue 24/06/2008 EQIA Yes / No 24/06/2008 Author / Contact Dr Leslie Cruickshank

More information

Management of High Blood Pressure in Adults Based on the Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC8)

Management of High Blood Pressure in Adults Based on the Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC8) Management of High Blood Pressure in Adults Based on the Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC8) Adapted by Capital Health Plan Approved by Quality Improvement

More information

Cardiac Rehabilitation (Outpatient Phase II) Corporate Medical Policy. Medical Policy

Cardiac Rehabilitation (Outpatient Phase II) Corporate Medical Policy. Medical Policy Cardiac Rehabilitation (Outpatient Phase II) Corporate Medical Policy File name: Cardiac Rehabilitation (Outpatient Phase II) File code: UM.REHAB.04 Origination: 08/1994 Last Review: 08/2011 Next Review:

More information

Diabetic Nephropathy

Diabetic Nephropathy Diabetic Nephropathy Kidney disease is common in people affected by diabetes mellitus Definition Urinary albumin excretion of more than 300mg in a 24 hour collection or macroalbuminuria Abnormal renal

More information

Guideline for Microalbuminuria Screening

Guideline for Microalbuminuria Screening East Lancashire Diabetes Network Guideline for Microalbuminuria Screening Produced by: Task and Finish Group, Clinical Standards Group Produced: August 2006 Approved by: East Lancashire Diabetes Network

More information

Stroke: Major Public Health Burden. Stroke: Major Public Health Burden. Stroke: Major Public Health Burden 5/21/2012

Stroke: Major Public Health Burden. Stroke: Major Public Health Burden. Stroke: Major Public Health Burden 5/21/2012 Faculty Prevention Sharon Ewer, RN, BSN, CNRN Stroke Program Coordinator Baptist Health Montgomery, Alabama Satellite Conference and Live Webcast Monday, May 21, 2012 2:00 4:00 p.m. Central Time Produced

More information

Institute of Applied Health Sciences. University of Aberdeen DATABASE REVIEW. Grampian University. Hospitals NHS Trust GRAMPIAN DIABETES

Institute of Applied Health Sciences. University of Aberdeen DATABASE REVIEW. Grampian University. Hospitals NHS Trust GRAMPIAN DIABETES DATABASE REVIEW Grampian University Hospitals NHS Trust GRAMPIAN DIABETES SERVICES DATABASE Page 1 Contents Contents 2 Introduction 3 History 3 Overview of Database 3 Database Structure 4 Main Table Summary

More information

HYPERTENSION ASSOCIATED WITH RENAL DISEASES

HYPERTENSION ASSOCIATED WITH RENAL DISEASES RENAL DISEASE v Patients with renal insufficiency should be encouraged to reduce dietary salt and protein intake. v Target blood pressure is less than 135-130/85 mmhg. If patients have urinary protein

More information

Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations.

Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations. INTRODUCTION Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations. Although decrease in cardiovascular mortality still major cause of morbidity & burden of disease.

More information

Board Review: Hypertension Cases

Board Review: Hypertension Cases Board Review: Hypertension Cases Cheryl L. Laffer, MD, PhD, FAHA Associate Professor of Medicine, Texas A&M HSC College of Medicine Senior Staff, S&W Nephrology / Hypertension (Remember, I didn t make

More information

Vascular Risk Reduction: Addressing Vascular Risk

Vascular Risk Reduction: Addressing Vascular Risk Vascular Risk Reduction: Addressing Vascular Risk Vascular Risk Reduction (VRR) Welcome! Presentation & Activities Focus: Managing known risk factors for vascular disease. Engage, collaborate and have

More information

Corporate Medical Policy Ambulatory Blood Pressure Monitoring

Corporate Medical Policy Ambulatory Blood Pressure Monitoring Corporate Medical Policy Ambulatory Blood Pressure Monitoring File Name: Origination: Last CAP Review: Next CAP Review: Last Review: ambulatory_blood_pressure_monitoring 7/1982 4/2016 4/2017 4/2016 Description

More information

Chronic Kidney Disease (CKD)Management in General Practice SUMMARY GUIDE

Chronic Kidney Disease (CKD)Management in General Practice SUMMARY GUIDE Chronic Kidney Disease (CKD)Management in General Practice SUMMARY GUIDE Early detection of CKD using kidney health check Who is at higher risk of kidney disease? Age > 50 years Diabetes High blood pressure

More information

Marilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL

Marilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL Marilyn Borkgren-Okonek, APN, CCNS, RN, MS Suburban Lung Associates, S.C. Elk Grove Village, IL www.goldcopd.com GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE GLOBAL STRATEGY FOR DIAGNOSIS, MANAGEMENT

More information

Population Health Management Program

Population Health Management Program Population Health Management Program Program (formerly Disease Management) is dedicated to improving our members health and quality of life. Our Population Health Management Programs aim to improve care

More information

The role of a low sodium diet in the management of hypertension. Dave Glover Consultant Nephrologist, Wrexham

The role of a low sodium diet in the management of hypertension. Dave Glover Consultant Nephrologist, Wrexham The role of a low sodium diet in the management of hypertension Dave Glover Consultant Nephrologist, Wrexham Salt Aims Is it all a bit Woman s Own / Daily Mail? Current guidelines An idea about salt What

More information

Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg

Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg 2 nd Annual Duke Renal Transplant Symposium March 1, 2014 Durham, NC Joseph G. Rogers, M.D. Associate

More information

Let s Do It Well. Nurse Learning Pack

Let s Do It Well. Nurse Learning Pack Let s Do It Well Nurse Learning Pack Let s Do It Well Nurse Learning Pack Reviewed and agreed by the British Hypertension Society (BHS) and the Nurses Hypertension Association (NHA) HIT is an independent

More information

Blood Pressure Classification. Blood Pressure Classification

Blood Pressure Classification. Blood Pressure Classification Blood Pressure Classification Blood Pressure Classification BP Classification SBP mmhg DBP mmhg Normal

More information

Chronic Kidney Disease and the Electronic Health Record. Duaine Murphree, MD Sarah M. Thelen, MD

Chronic Kidney Disease and the Electronic Health Record. Duaine Murphree, MD Sarah M. Thelen, MD Chronic Kidney Disease and the Electronic Health Record Duaine Murphree, MD Sarah M. Thelen, MD Definition of Chronic Kidney Disease (CKD) Defined by the National Kidney Foundation Either a decline in

More information

2/20/2015. Cardiac Evaluation of Potential Solid Organ Transplant Recipients. Issues Specific to Transplantation. Kidney Transplantation.

2/20/2015. Cardiac Evaluation of Potential Solid Organ Transplant Recipients. Issues Specific to Transplantation. Kidney Transplantation. DISCLOSURES I have no relevant financial relationships to disclose. Cardiac Evaluation of Potential Solid Organ Transplant Recipients Michele Hamilton, MD Director, Heart Failure Program Cedars Sinai Heart

More information

Hypertension Best Practices Symposium

Hypertension Best Practices Symposium essentia health: east region 1 Hypertension Best Practices Symposium RN Hypertension Management Pilot Essentia Health: East Region Duluth, MN ORGANIZATION PROFILE Essentia Health is an integrated health

More information

Chapter 11. Treatment of hypertension under special conditions

Chapter 11. Treatment of hypertension under special conditions (2009) 32, 70 77 & 2009 The Japanese Society of Hypertension All rights reserved 0916-9636/09 $32.00 www.nature.com/hr GUIDELINES (JSH 2009) Chapter 11. Treatment of hypertension under special conditions

More information

Objectives. Preoperative Cardiac Risk Stratification for Noncardiac Surgery. History

Objectives. Preoperative Cardiac Risk Stratification for Noncardiac Surgery. History Preoperative Cardiac Risk Stratification for Noncardiac Surgery Kimberly Boddicker, MD FACC Essentia Health Heart and Vascular Center 27 th Heart and Vascular Conference May 13, 2011 Objectives Summarize

More information

Drug Treatment in Type 2 Diabetes with Hypertension

Drug Treatment in Type 2 Diabetes with Hypertension Hypertension is 1.5 2 times more prevalent in Type 2 diabetes (prevalence up to 80 % in diabetic subjects). This exacerbates the risk of cardiovascular disease by ~ two-fold. Drug therapy reduces the risk

More information

Case Presentation: Mr. E.M. Dr. Braun

Case Presentation: Mr. E.M. Dr. Braun Case Presentation: Mr. E.M. Dr. Braun Case Presentation: Mr. E.M. 66 years old; PMHx CAD with stent 2010; carotid artery disease with stent 1999; aortic stenosis; CVA 1998; type 2 DM; colon cancer with

More information

RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY. Charles Jazra

RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY. Charles Jazra RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY Charles Jazra NO CONFLICT OF INTEREST TO DECLARE Relationship Between Atrial Fibrillation and Age Prevalence, percent

More information

CASE PRESENTATION AND QUESTIONS OF EXTRAORDINARY INSIGHT

CASE PRESENTATION AND QUESTIONS OF EXTRAORDINARY INSIGHT Hypertension: Justifying Those Ridiculously Complex Blood Pressure Tables Lucile Packard Children s Hospital Pediatric Residency Training Program Renal Learning Topics for Residents Abanti Chaudhuri, MD

More information

Emergency Scenario. Chest Pain

Emergency Scenario. Chest Pain Emergency Scenario Chest Pain This emergency scenario reviews chest pain in a primary care patient, and is set up for roleplay and case review with your staff. 1) The person facilitating scenarios can

More information

Understanding diabetes Do the recent trials help?

Understanding diabetes Do the recent trials help? Understanding diabetes Do the recent trials help? Dr Geoffrey Robb Consultant Physician and Diabetologist CMO RGA UK Services and Partnership Assurance AMUS 25 th March 2010 The security of experience.

More information

Resistant Hypertension, Sleep Apnea and Hyperaldosteronism. Faculty Disclosure

Resistant Hypertension, Sleep Apnea and Hyperaldosteronism. Faculty Disclosure Resistant Hypertension, Sleep Apnea and Hyperaldosteronism David A. Calhoun, M.D. Professor of Medicine Vascular Biology and Hypertension Program Center for Sleep/Wake Disorders University of Alabama at

More information

Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence

Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence Guidelines Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence Stroke/TIA Nearly 700,000 ischemic strokes and 240,000 TIAs every year in the United States Currently, the risk for

More information

Prescription Pattern of Anti Hypertensive Drugs used in Hypertensive Patients with Associated Type2 Diabetes Mellitus in A Tertiary Care Hospital

Prescription Pattern of Anti Hypertensive Drugs used in Hypertensive Patients with Associated Type2 Diabetes Mellitus in A Tertiary Care Hospital Research Article Prescription Pattern of Anti Hypertensive Drugs used in Hypertensive Patients with Associated Type2 Diabetes Mellitus in A Tertiary Care Hospital *T. JANAGAN 1, R. KAVITHA 1, S. A. SRIDEVI

More information

ORAL MEDICATIONS FOR MS! Gilenya and Aubagio

ORAL MEDICATIONS FOR MS! Gilenya and Aubagio ORAL MEDICATIONS FOR MS! Gilenya and Aubagio Champions against MS 4/20/13 Alexandra Goodyear, MD Stanford University Oral Medications Since 2010, 3 new oral medications for MS: Gilenya 2010 Aubagio 2012

More information

Cilostazol versus Clopidogrel after Coronary Stenting

Cilostazol versus Clopidogrel after Coronary Stenting Cilostazol versus Clopidogrel after Coronary Stenting Seong-Wook Park, MD, PhD, FACC Division of Cardiology, Asan Medical Center University of Ulsan College of Medicine Seoul, Korea AMC, 2004 Background

More information

PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES.

PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES. PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES. Hossam Bahy, MD (1992 2012), 19 tools have been identified 11 stroke scores 1

More information

How To Check Your Blood Pressure

How To Check Your Blood Pressure How To Check Your Blood Pressure Picking the Best Monitor for You Choose a proper size arm cuff. You should be able to slide one finger under the cuff and the lower edge should be one inch (2.5 cm) above

More information

U.S. Food and Drug Administration

U.S. Food and Drug Administration U.S. Food and Drug Administration Notice: Archived Document The content in this document is provided on the FDA s website for reference purposes only. It was current when produced, but is no longer maintained

More information

MISSING DATA ANALYSIS AMONG PATIENTS IN THE PINNACLE REGISTRY

MISSING DATA ANALYSIS AMONG PATIENTS IN THE PINNACLE REGISTRY MISSING DATA ANALYSIS AMONG PATIENTS IN THE PINNACLE REGISTRY In order to improve the efficiency of PINNACLE Registry data analytics, a missing data analysis has been conducted on PINNACLE Registry data

More information

Renal artery stenting: are there any indications left?

Renal artery stenting: are there any indications left? there any indications left? Luís Mendes Pedro, MD. PhD, FEBVS Lisbon Academic Medical Centre (University of Lisbon and Hospital Santa Maria) Instituto Cardiovascular de Lisboa Disclosures Speaker name:

More information

Diabetes, hypertension and a lot more `in the elderly` JORIS SCHAKEL INTERNIST- CLINICAL GERIATRICIAN JGSCHAKEL@SEHOS.CW

Diabetes, hypertension and a lot more `in the elderly` JORIS SCHAKEL INTERNIST- CLINICAL GERIATRICIAN JGSCHAKEL@SEHOS.CW Diabetes, hypertension and a lot more `in the elderly` JORIS SCHAKEL INTERNIST- CLINICAL GERIATRICIAN JGSCHAKEL@SEHOS.CW IT`S HARD TO GIVE GENERAL ADVICE! ``The Elderly`` Heterogeneous group ;widely varying

More information

Guidelines for the management of hypertension in patients with diabetes mellitus

Guidelines for the management of hypertension in patients with diabetes mellitus Guidelines for the management of hypertension in patients with diabetes mellitus Quick reference guide In the Eastern Mediterranean Region, there has been a rapid increase in the incidence of diabetes

More information

Isabella Sudano & Franco Muggli

Isabella Sudano & Franco Muggli Swiss Hypertension Guidelines Isabella Sudano & Franco Muggli CoLaus, Swisshype ESC 2005 Dokumentenname Datum Seite 1 European Journal of Cardiovascular Prevention and Rehabilitation 2009 Guideline...

More information

INHERIT. The Lancet Diabetes & Endocrinology In press

INHERIT. The Lancet Diabetes & Endocrinology In press INHibition of the renin angiotensin system in hypertrophic cardiomyopathy and the Effect on hypertrophy a Randomized Intervention Trial with losartan Anna Axelsson, Kasper Iversen, Niels Vejlstrup, Carolyn

More information

Atrial Fibrillation: Do We Have A Cure? Raymond Kawasaki, MD AMG Electrophysiology February 21, 2015

Atrial Fibrillation: Do We Have A Cure? Raymond Kawasaki, MD AMG Electrophysiology February 21, 2015 Atrial Fibrillation: Do We Have A Cure? Raymond Kawasaki, MD AMG Electrophysiology February 21, 2015 Disclaimer I have no relationships to disclose Do we have a cure for Atrial Fibrillation? The short

More information

Renal Disease in Type 2 Diabetes Mellitus

Renal Disease in Type 2 Diabetes Mellitus Renal Disease in Type 2 Diabetes Mellitus 6th Collaborative DiGP/HSE/UCC Conference 25 th September 2013 Dr. Eoin O Sullivan Consultant Endocrinologist Bon Secours Hospital Cork Case 69 year old woman

More information

Measurement of Blood Pressure

Measurement of Blood Pressure Measurement of Blood Pressure Ambulatory and Home Blood Pressure Monitoring BHS Non Medical Prescribing Update MSc. Management of Hypertension in Primary Care University of Birmingham February 2013 Louise

More information

Disability Evaluation Under Social Security

Disability Evaluation Under Social Security Disability Evaluation Under Social Security Revised Medical Criteria for Evaluating Endocrine Disorders Effective June 7, 2011 Why a Revision? Social Security revisions reflect: SSA s adjudicative experience.

More information

DIABETES MELLITUS. By Tracey Steenkamp Biokineticist at the Institute for Sport Research, University of Pretoria

DIABETES MELLITUS. By Tracey Steenkamp Biokineticist at the Institute for Sport Research, University of Pretoria DIABETES MELLITUS By Tracey Steenkamp Biokineticist at the Institute for Sport Research, University of Pretoria What is Diabetes Diabetes Mellitus (commonly referred to as diabetes ) is a chronic medical

More information

High Blood pressure and chronic kidney disease

High Blood pressure and chronic kidney disease High Blood pressure and chronic kidney disease For People with CKD Stages 1 4 www.kidney.org National Kidney Foundation's Kidney Disease Outcomes Quality Initiative Did you know that the National Kidney

More information

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk Lynne T Braun, PhD, CNP, FAHA, FAAN Professor of Nursing, Nurse Practitioner Rush University Medical Center 2

More information

SLEEP AND PARKINSON S DISEASE

SLEEP AND PARKINSON S DISEASE A Practical Guide on SLEEP AND PARKINSON S DISEASE MICHAELJFOX.ORG Introduction Many people with Parkinson s disease (PD) have trouble falling asleep or staying asleep at night. Some sleep problems are

More information

High Blood Pressure and Your Kidneys

High Blood Pressure and Your Kidneys High Blood Pressure and Your Kidneys About 65 million Americans have high blood pressure, but as many as one third or three in 10 don't even know it. There are usually no signs or symptoms that your blood

More information

Treatment of Hypertension: JNC 8 and More

Treatment of Hypertension: JNC 8 and More PL Detail-Document #300201 This PL Detail-Document gives subscribers additional insight related to the Recommendations published in PHARMACIST S LETTER / PRESCRIBER S LETTER February 2014 Treatment of

More information

CHEM 1406 BSA/BMI Measurement Laboratory (revised 01/03//06) BSA, Body Surface Area

CHEM 1406 BSA/BMI Measurement Laboratory (revised 01/03//06) BSA, Body Surface Area CHEM 1406 BSA/BMI (revised 01/03//06) BSA, Body Surface Area See pages 105-110 of dosage text for equations, calculations and adult nomogram See pages 270-273 of dosage calculation text for pediatric nomogram

More information

The new Heart Failure pathway

The new Heart Failure pathway The new Heart Failure pathway An integrated and seamless Strategy Dr Sunil Balani Definition of Heart Failure The inability of the heart to pump blood at a rate commensurate with the requirements of metabolising

More information

Preconception Clinical Care for Women Medical Conditions

Preconception Clinical Care for Women Medical Conditions Preconception Clinical Care for Women All women of reproductive age are candidates for preconception care; however, preconception care must be tailored to meet the needs of the individual. Given that preconception

More information

Renovascular Disease. Renal Artery and Arteriosclerosis

Renovascular Disease. Renal Artery and Arteriosclerosis Other names: Renal Artery Stenosis (RAS) Renal Vascular Hypertension (RVH) Renal Artery Aneurysm (RAA) How does the normal kidney work? The blood passes through the kidneys to remove the body s waste.

More information

Nutrition. Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT

Nutrition. Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT 1 Nutrition Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT 2 Type 2 Diabetes: A Growing Challenge in the Healthcare Setting Introduction and background of type 2 diabetes:

More information

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF)

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF) DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF) Key priorities Identification and diagnosis Treatment for persistent AF Treatment for permanent AF Antithrombotic

More information

Nova Scotia Guidelines for Acute Coronary Syndromes (Updating the 2008 Diabetes sections of the Guidelines)

Nova Scotia Guidelines for Acute Coronary Syndromes (Updating the 2008 Diabetes sections of the Guidelines) Cardiovascular Health Nova Scotia Guideline Update Nova Scotia Guidelines for Acute Coronary Syndromes (Updating the 2008 Diabetes sections of the Guidelines) Authors: Dr. M. Love, Kathy Harrigan Reviewers:

More information

NIHI Big Data in Healthcare Research Case Study

NIHI Big Data in Healthcare Research Case Study NIHI Big Data in Healthcare Research Case Study Professor Rob Doughty Heart Foundation Chair of Heart Health National Institute for Health Innovation and the Dept of Medicine, University of Auckland &

More information

Liver Function Essay

Liver Function Essay Liver Function Essay Name: Quindoline Ntui Date: April 20, 2009 Professor: Dr. Danil Hammoudi Class: Anatomy and Physiology 2 Liver function The human body consist of many highly organize part working

More information

High Blood Pressure and Kidney Disease

High Blood Pressure and Kidney Disease High Blood Pressure and Kidney Disease National Kidney and Urologic Diseases Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH The kidneys play a key

More information

MEDICAL POLICY SUBJECT: AUTOMATED AMBULATORY BLOOD PRESSURE MONITORING

MEDICAL POLICY SUBJECT: AUTOMATED AMBULATORY BLOOD PRESSURE MONITORING MEDICAL POLICY SUBJECT: AUTOMATED AMBULATORY 02/19/09 PAGE: 1 OF: 5 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product covers

More information

ATRIAL FIBRILLATION (RATE VS RHYTHM CONTROL)

ATRIAL FIBRILLATION (RATE VS RHYTHM CONTROL) ATRIAL FIBRILLATION (RATE VS RHYTHM CONTROL) By Prof. Dr. Helmy A. Bakr Mansoura Universirty 2014 AF Classification: Mechanisms of AF : Selected Risk Factors and Biomarkers for AF: WHY AF? 1. Atrial fibrillation

More information

Risk Factors of chronic complex co-morbidities. Aldo Pietro Maggioni, MD ANMCO Research Center Firenze, Italy

Risk Factors of chronic complex co-morbidities. Aldo Pietro Maggioni, MD ANMCO Research Center Firenze, Italy Risk Factors of chronic complex co-morbidities Aldo Pietro Maggioni, MD ANMCO Research Center Firenze, Italy Statement 1 In real world practice (and in clinical trials), complex co-morbidities are the

More information

HIGH BLOOD PRESSURE AND YOUR KIDNEYS

HIGH BLOOD PRESSURE AND YOUR KIDNEYS HIGH BLOOD PRESSURE AND YOUR KIDNEYS www.kidney.org About the Information in this Booklet Did you know that the National Kidney (NKF) Foundation offers guidelines and commentaries that help your healthcare

More information

Definition, Prevalence, Pathophysiology and Complications of CKD. JM Krzesinski CHU Liège-ULg Core curriculum Nephrology September 28 th 2013

Definition, Prevalence, Pathophysiology and Complications of CKD. JM Krzesinski CHU Liège-ULg Core curriculum Nephrology September 28 th 2013 Definition, Prevalence, Pathophysiology and Complications of CKD JM Krzesinski CHU Liège-ULg Core curriculum Nephrology September 28 th 2013 KI supplements January 2013 Objectives of the course on CKD:

More information

CLINICAL PRACTICE GUIDELINE

CLINICAL PRACTICE GUIDELINE CLINICAL PRACTICE GUIDELINE Procedure: Diabetes Guideline Review Cycle: Biennial Reviewed By: Amish Purohit, MD, MHA, CPE, FACHE Review Date: November 2014 Committee Approval Date: 11/12/2014 PURPOSE:

More information

Chronic Kidney Disease

Chronic Kidney Disease Chronic Kidney Disease Introduction Chronic kidney disease, also known as CKD, is the gradual loss of kidney function. When CKD reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes

More information

Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results

Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results Paul K. Whelton, MB, MD, MSc Chair, SPRINT Steering Committee Tulane University School of Public Health and Tropical Medicine, and

More information

Diabetes mellitus. Lecture Outline

Diabetes mellitus. Lecture Outline Diabetes mellitus Lecture Outline I. Diagnosis II. Epidemiology III. Causes of diabetes IV. Health Problems and Diabetes V. Treating Diabetes VI. Physical activity and diabetes 1 Diabetes Disorder characterized

More information

Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease

Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Home SVCC Area: English - Español - Português Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Martial G. Bourassa, MD Research Center, Montreal Heart Institute, Montreal, Quebec,

More information

Is it really so? : Varying Presentations for ACS among Elderly, Women and Diabetics. Yen Tibayan, M.D. Division of Cardiovascular Medicine

Is it really so? : Varying Presentations for ACS among Elderly, Women and Diabetics. Yen Tibayan, M.D. Division of Cardiovascular Medicine Is it really so? : Varying Presentations for ACS among Elderly, Women and Diabetics Yen Tibayan, M.D. Division of Cardiovascular Medicine Case Presentation 69 y.o. woman calls 911 with the complaint of

More information

CARDIO/PULMONARY MEDICINE FOR PRIMARY CARE. Las Vegas, Nevada Bellagio March 4 6, 2016. Participating Faculty

CARDIO/PULMONARY MEDICINE FOR PRIMARY CARE. Las Vegas, Nevada Bellagio March 4 6, 2016. Participating Faculty CARDIO/PULMONARY MEDICINE FOR PRIMARY CARE Las Vegas, Nevada Bellagio March 4 6, 2016 Participating Faculty Friday, March 4th: 7:30 am - 8:00 am Registration and Hot Breakfast 8:00 am - 9:00 am Pulmonary

More information

Type 1 Diabetes ( Juvenile Diabetes)

Type 1 Diabetes ( Juvenile Diabetes) Type 1 Diabetes W ( Juvenile Diabetes) hat is Type 1 Diabetes? Type 1 diabetes, also known as juvenile-onset diabetes, is one of the three main forms of diabetes affecting millions of people worldwide.

More information

Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology

Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology The chart below lists the measures (and specialty exclusions) that eligible providers must demonstrate

More information

Geriatric Cardiology: Challenges and Strategies

Geriatric Cardiology: Challenges and Strategies Geriatric Cardiology: Challenges and Strategies No financial disclosures Geriatrics -- No Specific Age 'you know it when you see it' Functional Status Polypharmacy Impaired Renal Function Diagnostic Testing:

More information

COMMITTEE FOR HUMAN MEDICINAL PRODUCTS (CHMP) DRAFT GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION

COMMITTEE FOR HUMAN MEDICINAL PRODUCTS (CHMP) DRAFT GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION European Medicines Agency London, 19 July 2007 Doc. Ref. EMEA/CHMP/EWP/311890/2007 COMMITTEE FOR HUMAN MEDICINAL PRODUCTS (CHMP) DRAFT GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR

More information

Current Management of Atrial Fibrillation DISCLOSURES. Heart Beat Anatomy. I have no financial conflicts to disclose

Current Management of Atrial Fibrillation DISCLOSURES. Heart Beat Anatomy. I have no financial conflicts to disclose Current Management of Atrial Fibrillation Mary Macklin, MSN, APRN Concord Hospital Cardiac Associates DISCLOSURES I have no financial conflicts to disclose Book Women: Fit at Fifty. A Guide to Living Long.

More information

COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION

COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION European Medicines Agency Pre-Authorisation Evaluation of Medicines for Human Use London, 25 September 2008 Doc. Ref. EMEA/CHMP/EWP/311890/2007 COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE

More information

Epidemiology of Hypertension 陈 奕 希 3120000591 李 禾 园 3120000050 王 卓 3120000613

Epidemiology of Hypertension 陈 奕 希 3120000591 李 禾 园 3120000050 王 卓 3120000613 Epidemiology of Hypertension 陈 奕 希 3120000591 李 禾 园 3120000050 王 卓 3120000613 1 Definition Hypertension is a chronic medical condition in which the blood pressure in the arteries is elevated. 2 Primary

More information

4/7/2015. Cardiac Rehabilitation: From the other side of the glass door. Chicago, circa 1999. Objectives. No disclosures, no conflicts

4/7/2015. Cardiac Rehabilitation: From the other side of the glass door. Chicago, circa 1999. Objectives. No disclosures, no conflicts Cardiac Rehabilitation: From the other side of the glass door No disclosures, no conflicts Charles X. Kim, MD, FACC, ABVM Objectives 1. Illustrate common CV benefits of CV rehab in real world practice.

More information

ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY. Guidelines for Use of Intravenous Isoproterenol

ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY. Guidelines for Use of Intravenous Isoproterenol ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY Guidelines for Use of Intravenous Isoproterenol Major Indications Status Asthmaticus As a last resort for

More information

ESC/EASD Pocket Guidelines Diabetes, pre-diabetes and cardiovascular disease

ESC/EASD Pocket Guidelines Diabetes, pre-diabetes and cardiovascular disease Diabetes, prediabetes and cardiovascular disease Classes of recommendations Levels of evidence Recommended treatment targets for patients with diabetes and CAD Definition, classification and screening

More information