jnc8 and current guidelines.10sow ga ihpc 14 30
DESCRIPTION
jnc8TRANSCRIPT
5/14/2014 1
JNC8 and Current Guidelines for Blood Pressure and
Cholesterol Management
May 12, 2014
Presented by
Martha White, BSN MBA Technical Advisor Alliant GMCF
Objectives
► Review the current hypertension screening guidelines
► Discuss the JNC8 Hypertension Management Guidelines
► Review current cardiovascular risk assessment
► Discuss the 2013 ACC/AHA Hyperlipidemia Guidelines
Blood Pressure Basics
BP = CO x TPR
Blood Pressure = Cardiac Output x
Total Peripheral Resistance
CO = Stroke Volume x Heart
Rate = the amount of blood
pumped by the heart per
minute
TPR = the resistance to blood
flow through the vascular
system
Screening for Hypertension
► The U.S. Preventive Services Task Force (USPSTF) recommends screening for high blood pressure in adults aged 18 and older. (This is a grade "A" recommendation)
► Screen:
– Every 2 years - blood pressure less than 120/80 mm Hg
– Yearly - systolic 120 -139 mm Hg or diastolic 80 - 89 mm Hg
U.S. Preventive Services Task Force. Screening
for high blood pressure: U.S. Preventive Services
Task Force recommendation statement. Ann
Intern Med 2007:147-783-786.
Screening for Hypertension (cont’d)
► Hypertension diagnosed - 2 or more elevated readings on at least 2 visits over a period of 1 to several weeks
► Hypertension definition - adults with:
– Systolic - of 140 mmHg or higher or
– Diastolic - of 90 mmHg or higher
U.S. Preventive Services Task Force.
Screening for high blood pressure: U.S.
Preventive Services Task Force
recommendation statement. Ann Intern
Med 2007:147-783-786.
Factors for Selecting Therapy for Hypertension Management
► Age
► Race
► Diabetes
► Kidney disease
► Cost
► Side effect profile
Lifestyle Management For Hypertension
► DASH diet ► Reduce sodium
(<1500mg/day) ► Increase physical
activity – 3 to 4 sessions a week,
– lasting on average 40 minutes
per session, and
– involving moderate to vigorous
intensity physical activities
► Weight loss
► Stress management
► Reduction of alcohol intake – if consuming >20 drinks per week
Eckel RH, Jakicic JM, Ard JD, et al, 2013 AHA/ACC
Guideline on Lifestyle Management to Reduce
Cardiovascular Risk, doi:
0.1016/j.jacc.2013.11.003.
U.S. Preventive Services Task Force. Screening for
high blood pressure: U.S. Preventive Services Task
Force recommendation statement.
Ann Intern Med 2007:147-783-786.
JNC8 Hypertension Guideline Management Algorithm
Age 60,+
Age <60
Any Age
+DM, -CKD
Any Age
+CKD, +/-DM
BP Goal
<150/<90
BP Goal
<140/<90
BP Goal
<140/<90
BP Goal
<140/<90
Initiate thiazide or ACEI or
ARB or CCB, alone or
combo
Initiate thiazide or
CCB, alone or combo
Initiate ACEI or ARB, alone
or combo w/other class
Non-black Black All races
ACEI = ACE Inhibitor ARB = Angiotensin Receptor Blocker CCB = Calcium Channel Blocker
Adapted from James PA, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth
Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. doi:10.1001/jama.2013.284427.
Cardiovascular Risk Assessment
► Risk factors – age, LDL-C, total and HDL-cholesterol, systolic BP, treatment status for hypertension, diabetes, current smoking status
► Applicable populations for risk calculator: – Non Hispanic Whites and African American
– Age 40-79 (10 year risk)
– Men and women
► Assess every 4-6 years if no ASCVD
Cardiovascular Risk Assessment
► Calculation of 10-year risk for first hard ASCVD event:
– Non-fatal myocardial infarction
– CHD death
– Fatal or non-fatal stroke
► Risk calculator not appropriate for those with
known ASCVD http://tools.cardiosource.org/ASCVD-Risk-Estimator/
Lifestyle Management for Reducing CV Risk
► Diet : – High in fruit and veggies, whole grains; low fat; limit
sweets – DASH diet
► Physical activity: – 3 to 4 sessions a week, lasting on average 40
minutes per session,
– involving moderate-to-vigorous intensity physical activity.
Eckel RH, Jakicic JM, Ard JD, et al, 2013 AHA/ACC
Guideline on Lifestyle Management to Reduce
Cardiovascular Risk, doi: 0.1016/j.jacc.2013.11.003.
2013 ACC/AHA Guidelines on the Treatment of Blood Cholesterol
Adapted from Stone NJ, et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the
American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013 Nov 12. [Epub ahead of print].
Clinical
ASCVD
LDL-C ≥
190 mg/dL
Diabetes
Age 40 - 75
High Intensity
10 Year
ASCVD Risk >
7.5% Age > 75
Moderate Intensity
No No
No
No
Yes
Yes
Yes
Yes
No
ASCVD = Atherosclerotic
cardiovascular disease
Yes
or
Yes
References
► U.S. Preventive Services Task Force. Screening for high blood pressure: U.S.
Preventive Services Task Force recommendation statement. Ann Intern
Med 2007:147-783-786.
► 2014 Evidence-Based Guideline for the Management of High Blood Pressure in
Adults: Report From the Panel Members Appointed to the Eighth Joint National
Committee (JNC 8). JAMA. 2014;311(5):507-520.
doi:10.1001/jama.2013.284427
► 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular
Risk. A Report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines. doi: 0.1016/j.jacc.2013.11.003
► ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce
Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College
of Cardiology/American Heart Association Task Force on Practice Guidelines.
Circulation. 2013 Nov 12. [Epub ahead of print].
► 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. A Report
of the American College of Cardiology/American Heart Association Task Force
on Practice Guidelines. 2013;01.cir.0000437741.48606.98published online
before print November 12 2013
This material was prepared by Alliant GMCF, the Medicare Quality Improvement Organization for Georgia, under contract with the Centers for Medicare & Medicaid Services
(CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 10SOW-GA-IHPC-14-30