Full Clinical Guidelines - Community First Health Plans.

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Causes of Resistant Hypertension • Improper BP measurement • Excess sodium intake • Inadequate diuretic therapy • Medication • Inadequate doses • Drug actions and interactions (e.g. nonsteroidal anti-inflammatory drugs (NSAIDs), illicit drugs, sympathomimetrics, oral contraceptives) • Over-the-counter (OTC) drugs and herbal supplements • Excess alcohol intake • Identifiable causes of hypertension Compelling Indications for Individual Drug Classes Compelling Indication • Heart failure • Post myocardial infarction • High CVD risk • Diabetes • Chronic kidney disease • Recurrent stroke prevention Initial Therapy Options THIAZ, BB, ACEI, ARB, ALDO ANT BB, ACEI, ALDO ANT THIAZ, BB, ACEI, CCB THIAZ, BB, ACEI, ARB, CCB ACEI, ARB THIAZ, ACEI Key: THIAZ = thiazide diuretic, ACEI = angiotensin converting enzyme inhibitor, ARB = angiotensin receptor blocker BB = beta blocker, CCB = calcium channel blocker, ALDO ANT = aldosterone antagonist Strategies for Improving Adherence to Therapy • Clinician empathy increases patient trust, motivation, and adherence to therapy • Physicians should consider their patients’ cultural believes and individual attitudes in formulating therapy Principles of Lifestyle Modification • Encourage healthy lifestyles for all individuals • Prescribe lifestyle modifications for all patients with prehypertension and hypertension • Components of lifestyle modifications include weight reduction, DASH eating plan, dietary sodium reduction, aerobic physical activity, and moderation of alcohol consumption Lifestyle Modification Recommendations Weight reduction DASH eating plan Dietary sodium reduction Aerobic physical activity Modification Recommendation Avg SBP Reduction † Maintain normal body weight (body mass index 18.5 – 24.9 kg/m 2 ) Adopt a diet rich in fruits, vegetables, and low fat dairy products with reduced content of saturated and total fat Reduce dietary sodium intake to ≤ 100 mmol per day (2.4 g sodium or 6 g sodium chloride) Regular aerobic physical activity (e.g., brisk walking) at least 30 minutes per day, most days of week Moderation of alcohol consumption Men: limit to ≤ 2 drinks* per day Women and lighter weight persons: limit to ≤ 1 drink* per day * 1 drink = ½ oz or 15 mL ethanol (e.g., 12 oz beer, 5 oz wine, 1.5 oz 80-proof whiskey † Effects are dose and time dependant 5 – 20 mmHg/10 kg 8 – 14 mmHg 2 – 8 mmHg 4 – 9 mmHg 2 -4 mmHg 1 Taken from National Institutes of Health (NHI) Guidelines on High Blood Pressure. National Institutes of Health and National Heart, Lung, and Blood Institute developed the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) , NIH Publication No. 03 - 5231, May 2003 94 H EALTH PLANS www.cfhp.com
11.3 Treatment of Hypertension H EALTH PLANS www.cfhp.com 95
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Community First Health Plans Qualit
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10.5 ATP III Classification of Chol
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Such information is released only t
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Non Voting • Martin Jimenez, Dire
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The purpose of these guidelines is
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Table 1. Adult Preventive Services
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Recommended Adult Immunization Sche
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Footnotes — Recommended Adult Imm
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CFHP has adopted the National Asthm
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Patient Name ______________________
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Managing Asthma Long Term 41 FIGURE
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FIGURE 14. CLASSIFYING ASTHMA SEVER
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FIGURE 16. STEPWISE APPROACH FOR MA
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FIGURE 20. CLASSIFYING SEVERITY OF
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II. Some hyperactive-impulsive or i
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COMMUNITY FIRST HEALTH PLANS BEHAVI
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Criteria Requirements 33. Release o
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The evaluation of breast disease is
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Prevent Child Texas, a non-profit o
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AMERICAN ACADEMY OF PEDIATRICS: Fai
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possible), a careful, complete, and
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Page 45 and 46: GLYCEMIC CONTROL BIBLIOGRAPHY • R
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Page 119 and 120: TEXAS MEDICAID PROVIDER PROCEDURES
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The following variables should be e
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CRITERIA 19. Unresolved Problems Fr
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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According to the National Institute
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. aminotransferase (AST) and alanin
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PREVENTION RECOMMENDATIONS 1. The E
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2 to 20 years: Boys Body mass index
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AsthmaMatters is an initiative deve
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According to the Centers for Diseas
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