Jnc 7 Adv Day1 Set2 Mmd Beal Htn

7/31/2019 Jnc 7 Adv Day1 Set2 Mmd Beal Htn

1/21

Hypertension JNC 7 Guidelines

The Seventh Report of theJoint National Committee on Prevention

www.nhlbi.nih.gov/guidelines/hypertension

Jeffrey Beal, M.D.

Clinical Director, Florida/CaribbeanAIDS Education and Training Center

AAHIVMS


2/21

Disclosure of Financial Relationships

Speakers Bureau: Bristol-Myers Squibb, Glaxo

This slide set has been peer-reviewed to ensure that there are no conflicts of

interest represented in the presentation.


3/21

All of the following are key

messages from JNC 7 except:1. Systolic BP > 140 mmHG is a much more

important CVD risk factor than diastolic BP in

persons >50 y/o2. The risk of CVD beginning at 115/75 mmHg

doubles with each increment of 20/10 mmHg

3. Thiazide-type diuretics are rarely indicated in

the treatment of hypertension4. Goal blood pressure for hypertensive patients

is


4/21

Which of the following is incorrect for the

proper measurement of BP in the officesetting?

1. Persons should be seated for at least 5

minutes resting before taking the BP

2. BP should be taken with the patient sitting onexam table with the arm relaxed in their lap

3. At least 2 measurements should be made

4. SBP is the point at which the first of two ormore sounds is heard

5. DBP is the point before the disappearance of

sound (phase 5)


5/21

Normal blood pressure is

defined in JNC 7 as:1.


6/21

JNC 7 Classification of BP1. Normal BP = < 120/80

2. Prehypertension = 120-139/80-893. Stage 1 HTN = 140-159/90-99

4. Stage 2 HTN = 160/100


7/21

Of the following lifestyle modifications, which

has the greatest potential reduction in SBP?

1. Weight loss to normal body weight (BMI

18.5-24.9 kg/m2)

2. Adopting the DASH eating plan

3. Dietary sodium restriction

4. Physical activity5. Moderation of alcohol intake


8/21

Recommendation SBP Reduction

Maintain normal body weight

(BMI 18.5-24.9 kg/m2)

5-20 mmHg/10 kg weight

loss

Diet rich in fruits, vegetables,

& fat dairy products with

reduced saturated and total fat

8-14 mmHg

Sodium to


9/21

Management of Hypertension 60 y/o HIV positive Black female has initial

and 3 subsequent office visits with

elevated BP by nurse Blood pressure 140/96, repeated 5

minutes later 142/92

Patient assessed as Stage 1 HTN


10/21

CV Risk Factors HTN

Cigarette Smoking Obesity: Weight 220lbs, height 56 = BMI35.5

Physically Inactive Dyslipidemia: Chol, HDL, Nl LDL/Trig.

Diabetes mellitus


11/21

CV Risk Factors Microalb. or Estimated GFR 55 for, > 65 FH premature CV disease (


12/21

Physical Exam BP equivalent in both arms

Grade II KW changes on funduscopic Waist circumference >40 , >35 (pt.42)

No carotid, abdominal, femoral bruit

Nl thyroid palpation, heart, lung andabdomen exam, lower ext. pulses, and

neurologic exam


13/21

Lab/other diagnostic ECG mild LVH

UA, Glucose, Hct., serum K+

, Creatinine,Ca++, Triglycerides normal

Chol. 230 mg/dL, HDL 30 mg/dL, LDL 88mg/dL


14/21

Identifiable Causes of HTN Sleep apnea

CKD

Primary aldosteronism (K+, fails HTN tx.) Renovascular ds.

Chronic steroids/Cushings syndrome

Pheochromocytoma Coarctation of aorta

Thyroid/Parathyroid disease


15/21

Medications Causing HTN NSAID, especially Cox-2 inhibitors Cocaine, amphetamine, other illicit drugs

Sympathomimetics (decongestants, anorectics) Oral contraceptives Adrenal steroids Cyclosporine and tacrolimus

Erythropoietin Licorice (including some chewing tobacco) OTC (ephedra, ma haung, bitter orange)


16/21

Lifestyle Modification Lifestyle modification education done

Weight loss and exercise

Low Na++, DASH diet

Low fat diet

Patient never drinks more than 4 oz. wine,2-3 meals per week


17/21

Patient Concomitant Medication Atazanavir 300 mg + Ritonavir 100 mg +

Truvada


18/21


19/21

What medication(s) would you

start?1. Diuretic therapy

2. ACE Inhibitor3. Angiotensin receptor blocker

4. Beta-blocker

5. Calcium channel blocker6. Diuretic plus one of the above


20/21

Generalizations for HTN/HIV No clinical studies to date with ARV

therapy and pharmacologic effect on

antihypertensive medications

Best to start with one drug and add usinglowest starting dose and increasing on at

least monthly visits if patient clinicallystable


21/21

Antihypertensive Drugs Diuretics: no drug interactions

Beta Blockers:

Monitor prolonged PR interval ATV Ritonavir can increase BB levels

NNRTI can BB levels

ACE inhibitors and ARB

Varied effect

Calcium Channel Blockers In general levels increased

Documents

Jnc 7 Adv Day1 Set2 Mmd Beal Htn