JNC 8 Hypertension Guidelines - ACP

60 Pages·2014·8.46 MB·English

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JNC 8 Hypertension Guidelines
ACP Arizona Chapter Annual Meeting 2014
Shakaib Rehman, MD, SCH, FACP, FAACH
Associate Chief of Staff for Education
Phoenix VA Healthcare Systems
Professor of Medicine
Professor of Biomedical Informatics
University of Arizona College of Medicine-Phoenix
Disclosure/COI
• None
The burden of disease
> 32.5% of US
population
(2011-2012)
Source: Health, United States, 2013, table 64
Would all of us develop
hypertension?
• Individuals who are normotensive
at 55 years have a 90% likelihood
of developing high blood pressure
during the next 25 years
• Vasan RS, Beiser A, Seshadri S, et al. Residual lifetime risk for developing hypertension in middle-
aged women and men: The Framingham Heart Study. JAMA. 2002;287:1003-1010
Case
• 38 year old AA woman New patient
coming in with cold noted BP 138/99
mmHg (untreated)
• Strong family history of hypertension
(parents, 2 older sibs)
• Exam/evaluation unremarkable
One Million Hypertensives
Can't Be Wrong
Meta-analysis of one million adults aged 40 to 89 in 61
prospective observational studies.
• Changes in SBP of 20 mm Hg or DBP of
10 mm Hg associated with a two-fold
difference in death from ischemic heart
disease, stroke or other vascular reasons.
• LewingtonS, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis
of individual data for one million adults in 61 prospective studies. Lancet. 2002; 360:1903
CV Mortality Risk Doubles with
Each 20/10 mm Hg BP Increment
8
7
6
5 115/75
135/85
4
155/95
3
175/105
2
1
0
CV Mortality Risk
LANCET 2002;60:1903-13
JNC VII JAMA 2003;289:2560-72
Impact of Treating Hypertension
0
-10
-16
-20
-21
-30
Percentage of Change
-38
-40
-50
-52
-60
CHF CVA CVD CHD
Moser M, Hebert PR. Prevention of disease progression, left ventricular hypertrophy and congestive heart failure in
hypertension treatment trials. J Am Coll Cardiol 1996;27:1214–8.
Neal B, MacMahon S, Chapman N. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering
drugs. Lancet.2000;356:1955-1964
Which one of the following predicts
CV mortality more accurately?
Systolic HTN
or
Diastolic HTN
Relative Importance of DBP and SBP as
Predictors of CHD as a Function of Age
1.0
Favors SBP
0.5
0.0
(SBP)
-
(DBP) -0.5 P=0.008
*
Favors DBP
-1.0
-1.5
25 35 45 55 65 75
Age (y)
CHD, coronary heart disease.
*The difference between SBP and DBP proportional hazard regression
coefficients, ie, (SBP) - (DBP), was estimated for each age group.
Franklin SS et al. Circulation. 2001;103:1245-1249.