Category:

Clinical Management of Hypertention

By
Marvin Moser, MD

Course Outline

The eighth edition of Clinical Management of Hypertension continues to update hypertension treatment recommendations with additions and interpretations of new data from treatment trials and guideline committees. The management guidelines of the Seventh Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure are again reviewed and critiqued in view of new data since these were originally published in 2003. The validity of advising a thiazide diuretic as initial therapy is put in perspective. The 2007 European Society of Hypertension and Society of Cardiology guidelines and new treatment algorithms are also reviewed and evaluated. Recently introduced antihypertensive agents, such as a renin inhibitor and a beta blocker with nitric oxide-enhancing properties, as well as newer combination therapies, are discussed.

Above all, this updated edition of Clinical Management of Hypertension sends a clear message that more individuals with hypertension, especially in the older age groups, should be treated; effective and safe treatment is available; and achieving levels of BP as close to normal as possible-120-130/80 mm Hg-will reduce morbidity and mortality to an even greater degree than has occurred to date.

About Authors

Marvin Moser, MD is Clinical Professor of Medicine at the Yale University School of Medicine and was the senior medical advisor to the National High Blood Pressure Education Program of the National Heart, Lung and Blood Institute (NHLBI) from 1974 to 2002. He was Chairman of the first Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in 1977, Vice-Chairman of the committee in 1980, and has participated in each of the other five JNCs. Dr. Moser is Editor in Chief of the Journal of Clinical Hypertension and the author of more than 500 scientific papers, 32 book chapters, and 11 books. These include Myths, Misconceptions and Heroics, the Story of the Treatment of Hypertension, published in 1997 and 2002, and Clinical Management of Cardiovascular Risk Factors in Diabetes (2002, 2007) (with James Sowers, MD)

He has received numerous awards, including awards from the NHLBI in 1985 and 1997, an International Society of Hypertension Award in 2004, and an American Society of Hypertension Award in 2006, for his contributions in the field of hypertension research and treatment.

Learning Objectives

After completing this course you’ll be able to:

  1. Discuss systolic and diastolic blood pressure and the treatment.
  2. State the optimal blood pressure in an adult.
  3. Discuss “prehypertension.”
  4. State when treatment for hypertension should begin.
  5. Define “white-coat” hypertension.
  6. Describe “non-dippers.”
  7. Discuss weight loss techniques.
  8. Discuss sodium restriction and define those who are “salt sensitive.”
  9. Discuss dietary supplementation of potassium.
  10. Describe exercise techniques, relaxation programs, and biofeedback to reduce blood pressure.
  11. Discuss a follow-up program for hypertension.
  12. Discuss the suggested approach to manage a patient with an initial blood pressure of 140/90 mm Hg or greater. (Table 4.2)
  13. Discuss findings of ALLHAT and CONVINCE trials.
  14. Describe the J-shaped curve.
  15. Discuss the guidelines from 1999 regarding the World Health Organization International Society of Hypertension.
  16. Describe the four classifications of diuretics and give an example of each.
  17. Discuss the physiological effects of diuretics according to Figure 5.3.
  18. Discuss side effects that occur with diuretics.
  19. State the type of patient where loop diuretics are most effective.
  20. Describe the ACE inhibitors and how they lower blood pressure.
  21. Discuss the HOPE and HOPE-TOO study.
  22. Discuss the Swedish Trial in Old Patients With Hypertension2.
  23. Describe the ALLHAT trial and findings.
  24. List side effects of ACE inhibitors.
  25. State the effectiveness of ACE inhibitors in various populations and in those with renovascular disease.
  26. Discuss how angiotensin 11 receptor blockers lower blood pressure.
  27. Describe nitric oxide.
  28. Discuss the use of angiotensin receptor blockers in the diabetic patient.
  29. Discuss the role of renin in the hypertensive patient.
  30. Discuss how calcium blockers lower blood pressure.
  31. Compare the nondihydropyridine calcium channel blockers and the dihydropyrididine channel blockers.
  32. Describe the Hypertension Optimal Treatment Trial.
  33. Compare side effects of the shorter-acting and longer-acting calcium channel blockers.
  34. Discuss the Anglo Scandinavian Cardiac Outcomes Trial.
  35. List the conditions in which B-blockers would exacerbate a medical problem.
  36. Describe the ways B-blockers lower blood pressure.
  37. Discuss lipid soluable B-blockers and give examples.
  38. Discuss the patients for which B-blockers are particularly effective.
  39. List several side effects of B-blockers.
  40. List the three combinations of B-blockers with vasodilating properties and side effects.
  41. List the three selective a1-blockers available in the United States and their action on smooth muscle.
  42. Discuss the peripheral adrenergic inhibitors including why they are seldom used.
  43. List the available central agonists and how they lower blood pressure.
  44. Discuss side effects of central agonists.
  45. Discuss the two drugs that are direct vasodilators and their side effects.
  46. Describe the characteristics of an ideal medication for initial therapy.
  47. List several guidelines in selecting a step-1 drug.
  48. Discuss multiple drug therapy.
  49. Discuss causes for nonresponsiveness to therapy.
  50. Discuss several studies describing better management of hypertension and the reduction in complications.

Course Contents

  1. Introduction
  2. Diagnosis
  3. Lifestyle Modifications
  4. Drug Treatment of Hypertension: General Information
  5. Diuretics
  6. Ace Inhibitors
  7. Angiotension 11 Receptor Blockers
  8. Renin Inhibitors
  9. Calcium Channel Blockers
  10. B-Blockers
  11. B-Blockers With Vasodilating Properties
  12. a1-Blockers
  13. Peripheral Adrenergic Inhibitors
  14. Central Agonists
  15. Direct Vasodilators
  16. Approach to Treatment: Combination Therapy
  17. Management of the Patient With Resistant Hypertension
  18. Results of Therapy