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KEY POINTS - Southern Medical Association

KEY POINTS - Southern Medical Association

KEY POINTS - Southern Medical

What Have We learned Since JNC 7: What Might We Expect in JNC 8 SMA 14 th Annual Conference on Hypertension, Diabetes, Dyslipidemia, Marriott Sawgrass Ponte Vedra Beach, Florida August 7, 2010 Jan Basile, MD Professor of Medicine Seinsheimer Cardiovascular Health Program Division of General Internal Medicine⁄Geriatrics Medical University of South Carolina Ralph H. Johnson VA Medical Center Charleston, SC DISCLOSURE OF FINANCIAL RELATIONSHIPS 2010 Jan N. Basile, MD Grant/Research support: Consultant: Speakers Bureau: Major stock shareholder: Other: NHLBI (ACCORD) NHLBI (SPRINT) Daiichi-Sankyo, Forest ,Novartis, Takeda AstraZeneca, Boehringer- Ingelheim, Daiichi-Sankyo, Forest, Novartis None None KEY POINTS • The amount of BP reduction is the major determinant of reduction in cardiovascular risk in both younger and older patients with hypertension, not the choice of antihypertensive drug. • Adding the DHP-CCB Amlodipine to an ACE inhibitor in those with Diabetes, CAD, post-MI or stroke improves outcome more than adding the thiazide-type diuretic Hctz to an ACE inhibitor. • An ACE Inhibitor and an ARB appear equivalent for outcome improvement in patients with underlying vascular disease or in those with diabetes that are at high-risk. The ARB is associated with fewer side effects. KEY POINTS • Using an ACE inhibitor and ARB together in this same patient population does not reduce BP much, does not improve outcome over either agent alone, and is associated with more side effects. • We are doing better in the treatment and control of BP. JNC 8 should include -a global risk chart to allow us to understand that BP elevation is only 1 factor that contributes to hypertension morbidity and mortality - an evidenced-based approach to goal BP targets - Class effect vs within class differences - The importance of out-of-office BP measurement - The importance of getting to goal sooner rather than later Why Are We Still Talking About Hypertension? • NHANES 2007-2008 – The prevalence of hypertension increased significantly between 1988–1994 and 1999–2000 but remained stable between 1999–2000 and 2007–2008. – Controlled hypertension (BP

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