Management of the Moderate to Severe Hypertensive: Individualizing Treatment to Maximize Outcomes |
Hypertension significantly increases the risk for stroke, cardiovascular disease (CVD), kidney disease, atherosclerosis, and death—and its prevalence is increasing. Nearly 1 in 3 individuals in the United States has hypertension. People with diabetes have a 2- to 4-fold increased risk of CVD compared to the general population. However, a person with diabetes and hypertension has triple the already increased risk of CVD and double the total mortality and stroke risk. These people also have a 5- to 6-fold greater risk of developing end-stage renal disease (ESRD) compared with people with hypertension and no evidence of diabetes. The data from numerous trials demonstrate that very aggressive combination therapy with multiple classes of antihypertensive agents will usually be necessary to achieve the standards for control of hypertension as outlined in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). These data showed that the average number of different antihypertensive classes needed to achieve BP goals was between 2 and 4. Studies also indicate that the different mechanisms of action of the agents used for combination treatment regimens may act synergistically, thus allowing the use of lower dosages of each agent, which improves safety and tolerability. Clinical trials have provided evidence-based outcomes that prove interventions to the renin-angiotensin-aldosterone system (RAAS) are effective in the prevention of diabetes and diabetic nephropathy. In addition to addressing the effect hypertension and diabetes have on the pathogenesis of hypertensive renal damage, this program will underscore the need for early, aggressive, combination treatment in order to reach JNC 7 blood pressure goals in high-risk patients, such as patients with diabetes and hypertension. It will explain the mechanisms of action of the various antihypertensive drug classes and how clinicians can use this understanding when selecting a drug regimen. Based on recent and ongoing trials, the safest and most efficacious drug combinations will be discussed. Learning Objectives
Accreditation/Designation Statement Primary Care Network designates this educational activity for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Release Date: Februrary 23, 2009 Acknowledgement of Commercial Support: This activity was developed from the live Best Practices in Primary Care™ program held in Philadelphia, Pennsylvania on April 26, 2008 which was funded by Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership. Method of Participation: Post-test and Evaluation: Statement of Disclosure and Independence: Primary Care Network’s Resolution of Personal Conflicts of Interest (COI) Policy aims to ensure that all conflicts are resolved prior to the activity, content is developed and presented free of commercial bias, and is in the interest of promoting improvements or quality in healthcare. All individuals who are in a position to influence and/or control content of a Primary Care Network sponsored activity are required to disclose to the participants any real or apparent conflict of interest related to the activity. The educational content is also reviewed for independence and content validation by an independent external clinical reviewer and internal clinical reviewer. Independence is also monitored through the activity and overall program evaluation process. The opinions, ideas, recommendations, and perspectives expressed in the accompanying presentations at this Primary Care Education program are those of the program authors and presenting faculty only and do not necessarily reflect the opinions, ideas, recommendations or perspectives of their affiliated institutions, Primary Care Network, Primary Care Education, Advisory Boards and Consultants, or the activity’s commercial supporters. Planning Committee and Disclosures John Steinberg, MD Dr. Steinberg is a member of the speaker’s bureau for, serves on the advisory boards of, and is a consultant to Bristol-Myers Squibb Company and Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership. He is also a member of the speaker’s bureau for Novartis Pharmaceuticals, Novo Nordisk, and sanofi-aventis US. Dr. Steinberg also serves on the advisory boards of Novartis and sanofi-aventis and he is a consultant to sanofi-aventis. Raymond Townsend, MD Dr. Townsend is a member of the speaker’s bureau for Merck & Co., Inc. He is a consultant to Abbott Laboratories and Bristol-Myers Squibb Company and he receives grant support from Novartis Pharmaceuticals. Lee Sullivan, PhD Dr. Sullivan has no commercial relationships to disclose. Diane Hammerle Ms. Hammerle has no commercial relationships to disclose. Sue Landry Ms. Landry has no commercial relationships to disclose. Faculty and Disclosures Dr. Altus is a consultant to King Pharmaceuticals, Inc. He is a member of the speaker’s bureau for the Bristol-Myers Squibb Company, Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership, King, and sanofi-aventis US. Domenic A. Sica, MD Dr. Sica is a consultant to Johnson & Johnson. He receives grant support from GlaxoSmithKline and serves on the advisory board for Boehringer Ingelheim, Bristol-Myers Squibb Company, Merck & Co., Inc., Novartis Pharmaceuticals, and Takeda Pharmaceuticals North America, Inc. He also is a member of the speaker’s bureau for Novartis. Review Committee Disclosure
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