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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Getting To Goal: Effective Control Of Hypertension


GOAL
To provide cardiologists, family practitioners, internal medicine physicians, general practitioners, and doctors of osteopathy with up-to-date information on the treatment and management of patients with hypertension.

TARGET AUDIENCE
This activity is designed for cardiologists, family practitioners, internal medicine physicians, general practitioners, and managed care clinical decision makers. No prerequisites required.

LEARNING OBJECTIVES
The Johns Hopkins University School of Medicine and the University of Tennessee College of Pharmacy take responsibility for the content, quality, and scientific integrity of this CE activity. At the conclusion of this activity, the participant should be able to:

  • Provide physicians with guidance on the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7).
  • Review treatment guidelines and evaluate antihypertensive treatment options.
  • Develop a patient management strategy that emphasizes lifestyle modifications accompanied by appropriate drug treatment.
  • Evaluate clinical trials to understand the implications of different treatment options and the long-term use of antihypertensive drugs.  
  • Understand the public health and economic impact of reducing hypertension.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of Tennessee College of Pharmacy is approved by the Accreditation Council for Pharmacy Education as a provider of continuing pharmaceutical education.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 category 1 credits toward the AMA Physician's Recognition Award.

This program is approved for 2 hours (0.2 CEUs) and is cosponsored by the University of Tennessee College of Pharmacy, which is approved by the American Council on Pharmacy Education as a provider of continuing pharmaceutical education. A statement of CE credit will be mailed within 4 weeks of successful completion and evaluation of the program. ACPE program #064-000-05-202-H01.

Each participant should claim only those credits that he/she actually spent in the activity.

The estimated time to complete this educational activity: 2 hours.
Release date: June 15, 2005. Expiration date: June 15, 2007.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the Johns Hopkins University School of Medicine, and the University of Tennessee College of Pharmacy names implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an educational grant from Sankyo Pharma Inc. and Forest Pharmaceuticals, Inc.

Full Disclosure Policy Affecting CME Activities:
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Director and Participating Faculty reported the following:

PROGRAM DIRECTOR

Roger S. Blumenthal, MD
Associate Professor of Medicine
Department of MedicineÐCardiovascular
Johns Hopkins Ciccarone Center
Johns Hopkins University School of Medicine
Baltimore, Maryland
Dr Blumenthal reports receiving grants/research support and occasional honoraria from AstraZeneca, KOS Pharmaceuticals Inc, Merck and Company, Pfizer Inc, and  Wyeth Pharmaceuticals over the past 3 years.

PARTICIPATING FACULTY

Joseph L. Izzo, Jr, MD
Professor of Medicine
SUNY
Buffalo, New York
Dr Izzo reports receiving grants/research support from Alteon, GlaxoSmithKline, Novartis, Omron, Pfizer Inc, and Sankyo Pharma; serving as a consultant for Alteon, AstraZeneca, GlaxoSmithKline, Intercure, Merck and Company, Novartis, Omron, and Sankyo Pharma; and serving on the speakerÕs bureau for AstraZeneca, Biovail, Boehringer-Ingelheim, Merck and Company, Novartis, Pfizer Inc, and Sankyo Pharma.

C. Venkata S. Ram, MD, FACC, MACP
Director, Texas Blood Pressure Institute
Dallas Nephrology Associates
Clinical Professor of Internal Medicine
University of Texas Southwestern Medical Center
Dallas, Texas
Dr Ram reports serving as a consultant or on the speakerÕs bureau for Abbott Laboratories, AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb Company, Elan Corporation, Eon Labs Inc, Forest Laboratories Inc, King Pharmaceuticals Inc, KOS Pharmaceuticals Inc, Knoll Inc, Merck and Company, Novartis, Pfizer Inc, Pharmacia Corporation, Reliant Pharmaceuticals, Roche, Sankyo Pharma, Sanofi-Synthelabo US, Searle/Monsanto Company, Solvay Pharmaceuticals Inc, Unimed Pharmaceuticals Inc, Wellspring Pharmaceuticals, and Wyeth Pharmaceuticals.

Notice: The authors have indicated that this CE activity contains no mention of unlabeled/unapproved uses of drugs or devices.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Getting To Goal: Effective Control Of Hypertension
Roger S. Blumenthal, MD

Diseases related to hypertension currently affect millions of Americans, at an annual cost exceeding $50 billion. This issue of Advanced Studies in Medicine is dedicated to supporting and promoting effective detection, prevention, and treatment of hypertension and reducing the societal cost of this potentially devastating but widely underdiagnosed and undertreated condition. Information presented here supports and reinforces ongoing national efforts to reduce human and economic costs associated with hypertension and profiles current recommendations of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), which offer a practical plan for improving hypertension detection and treatment in any practice setting.

In this monograph, Dr Joseph L. Izzo, Jr, briefly reviews the pathophysiology of hypertension and describes the stroke and vascular disease mortality reductions that can be achieved among patients who reach the JNC-7Ðdesignated blood pressure target of less than 140/90 mm Hg, or less than 130/80 mm Hg for those patients with diabetes or chronic kidney conditions. Dr Izzo summarizes new recommendations evident in the JNC-7 guidelines, reviews available drug treatment options, and  offers useful caveats regarding agent selection. He  also discusses treatment with particular therapeutic agents as considerations for patients with compelling indications for diabetes mellitus, chronic kidney disease, cardiac failure, coronary heart disease/high coronary risk, or recurrent stroke.

Treatment of patients at high risk for hypertension is further elaborated in my article, in which I discuss agent selection for patients with concurrent conditions, such as heart disease or diabetes mellitus. I present a treatment algorithm from the JNC-7 guidelines, which incorporate new recommendations and key messages for comprehensive treatment of primary hypertension and discuss the essential lifestyle modifications that continue to be important for all patients with hypertension. I also present important issues related to selecting first-line treatment, which is often a combination therapy approach in patients more than 20 mm Hg above their systolic and more than 10 mm Hg above their diastolic blood pressure targets.

Dr C. Venkata S. Ram discusses public health implications of hypertension, including the proven role of improved blood pressure control in reducing cardiac risk and preventing or delaying chronic kidney disease. Dr Ram also presents significant public health opportunities for the prevention of hypertension, shares important advice about treatment-related quality-of-life concerns, and includes useful suggestions for patient compliance improvement and treatment cost reduction. The epidemiology of hypertension, a challenging problem that currently is widespread in American society, is presented and discussed throughout the monograph.

*Associate Professor of Medicine, Department of MedicineÐ Cardiovascular, Johns Hopkins Ciccarone Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Address correspondence to: Roger S. Blumenthal, MD, Associate Professor of Medicine, Department of MedicineÐ Cardiovascular, Johns Hopkins Ciccarone Center, Johns Hopkins University School of Medicine, 600 North Wolfe StreetÐBlalock 524 C, Baltimore, MD 21287.
E-mail:
rblument@jhmi.edu.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.