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Essential Hypertension [2014 update]

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Posttest
Evaluation
Release Date: Wed, 1/1/20
Termination Date: Thu, 12/31/20
Credits: 1
Description: Approximately 25% of adults in the United States adults have elevated hypertension. Half of these people have no medication prescribed, and half of the people on medication are not controlled. Uncontrolled hypertension results in end stage organ damage, which leads to significant mortality and morbidity. The purpose of this educational activity is to help clinicians understand and implement clinical care to:
  1. accurately diagnose hypertension,
  2. improve blood pressure (BP) control,
  3. decrease hypertension-related morbidity and mortality,
  4. encourage patient's self-involvement,
  5. provide appropriate education and follow-up, and
  6. provide cost-effective care.

New aspects of care addressed in this update include:
  • Options for preferred initial drug treatment have expanded beyond thiazide diuretics to include calcium channel blockers and ACE inhibitors.
  • Earlier initiation of dual antihypertensive medications is emphasized, particularly with calcium channel blocker and renin/angiotensin system inhibitor (e.g., ACE inhibitor).
  • Systolic and diastolic BP control for patients with diabetes and chronic kidney disease is less strict, with the target systolic BP now < 140 mmHg (instead of < 130) and diastolic BP < 90 mmHg, although diastolic BP < 80 mmHg may still be considered.

Key aspects of care are:
  • Diagnosis is best using mean BP levels over several visits, and careful calibration of the BP monitor.
  • Target for BP therapy is:
    • < 140/90 mm Hg for patients
      • Age 18 to 59 years without diabetes or renal insufficiency
      • Age ≥ 18 years with diabetes, renal disease, cardiovascular disease or cerebrovascular disease
    • < 150/90 for patients aged 60 years or older without diabetes, renal disease, cardiovascular disease or cerebrovascular disease.
  • Thiazide diuretics, calcium channel blockers and ACE inhibitors are generally the preferred initial drug treatment.
  • Add second and third agents as needed. The combination of calcium channel blocker and renin/angiotensin system inhibitor (e.g., ACE inhibitors, angiotensin receptor blocker) is increasingly viewed as the drug combination of choice.
  • Patient education and self-management are fundamental to successful therapy.
Educational Objectives: Participants in this CME activity will understand and be able to implement evidence-based cost-effective clinical strategies for the diagnosis and treatment of hypertension in adults over age 18.
Target Audience: This self-study activity is appropriate for primary care clinicians and other health care providers who diagnose and treat hypertension in adults.
Accreditation Information: The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Original Release Date:May 2014
Termination Date: June 2022

Continued availability of CME credit for this activity depends on a thorough review of its content every three years. This activity was last reviewed for currency and accuracy in June 2019, and availability of CME credit continued.
Additional Info: Authors:
Masahito Jimbo, MD; Family Medicine
Michael P Dorsch, PharmD; Pharmacy
Mark W Ealovega, MD; General Medicine
R Van Harrison, PhD; Medical Education
Kenneth A Jamerson, MD; Cardiovascular Medicine

Financial Disclosure Information:
Michael P Dorsch, PharmD
Speakers Bureau: Astra/Zeneca, Boehringer Ingelheim, Jansen

Kenneth Jamerson, MD
Research support, Consultant, Speakers Bureau: Novartis, Astra/Zeneca, Boehringer Ingelheim, Novartis, Takeda, Daiich Sankyo

There are no other relevant financial relationships to disclose for this CME activity.

UMHS Guidelines Oversight Team:
Karl T. Rew, MD
R. Van Harrison, PhD

Literature Search Services:
Taubman Medical Library

Credits available:

AMA PRA Category 1: 1.00
Participation: 1.00