This program is supported through an independent educational grant from Takeda Pharmaceuticals U.S.A., Inc.

Transcription

1 RELEASE DATE: 10/12/13 PROGRAM ID: This program was developed by the American Association of Nurse Practitioners in cooperation with MCM Education, Newtown, PA. This program is supported through an independent educational grant from Takeda Pharmaceuticals U.S.A., Inc. This publication is designed to complement the presentation titled Contemporary Management of Hypertension: Applying the Latest Evidence. None of the content may be reproduced in any form without prior written permission from the publisher. The opinions expressed in this publication and related educational event are those of the speakers and do not necessarily reflect the opinions or recommendations of the affiliated institutions, the publisher, the American Association of Nurse Practitioners, or Takeda Pharmaceuticals U.S.A., Inc. The content of the printed slides in this syllabus was accurate as of the publication date. Some slides may have been updated for the live presentation. This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, attendees/participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program. This program is approved for 1.0 contact hour of continuing education (which includes 0.25 hour of pharmacology) by the American Association of Nurse Practitioners. Program ID This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards The American Association of Nurse Practitioners. All rights reserved. 1

2 Needs Statement Hypertension is a major risk factor for heart disease, stroke, heart failure, and kidney disease. According to recent estimates from the American Heart Association, nearly 1 in 3 adults in the United States (more than 76 million people) have hypertension. While there have been improvements within the last two decades in blood pressure awareness, treatment, and control, suboptimal blood pressure control continues to lead to significant morbidity and mortality. Only about half of US adults who are aware that they have hypertension have their blood pressure controlled. Nurse practitioners can play a key role in closing this gap by helping patients with hypertension overcome barriers to blood pressure control. Nurse practitioners are uniquely positioned to help patients achieve better blood pressure control by 1) following clinical practice guidelines for the management of hypertension; 2) tailoring hypertension treatment for individual patients based on current evidence; and 3) promoting patient adherence to hypertension treatment regimens. The goal of this activity is to improve the management of hypertension by nurse practitioners, ultimately leading to better blood pressure control and improved outcomes for patients. FAC ULTY Leslie L. Davis PhD, RN, ANP-BC, FAANP, FAHA Assistant Professor of Nursing University of North Carolina, Greensboro Greensboro, NC Clinical Assistant Professor of Medicine University of North Carolina, Chapel Hill Chapel Hill, NC Leslie L. Davis is an Assistant Professor of Nursing at the University of North Carolina, Greensboro. Since 2000 she has maintained a part-time practice as a nurse practitioner in cardiology at UNC-Chapel Hill. As a clinician, she has focused her care on patients with hypertension, heart failure, and acute coronary syndromes. Dr. Davis has served as faculty and chair for a specialty series on cardiovascular topics for the American Association of Nurse Practitioners in 2010 and 2011 and on the American Heart Association s Go Red for Women Task Force in She has authored and coauthored articles in the American Journal of Critical Care, Circulation, Heart and Lung, the Journal of the AANP, and Progress in Cardiovascular Nursing. She is also serving as a guest editor for a special edition (December 2013) of The Journal for Nurse Practitioners, focusing on cardiovascular issues. Leslie L. Davis, PhD, RN, ANP-BC, FAANP, FAHA, has no conflicts of interest to disclose. Mary Ellen E. Roberts DNP, RN, APNC, FAANP, FAAN Assistant Professor Graduate Department College of Nursing Seton Hall University South Orange, NJ Mary Ellen E. Roberts is an Assistant Professor of Nursing and Director of the DNP program at Seton Hall University College of Nursing. Dr. Roberts received her BSN at the College of Saint Elizabeth, her MSN and MA from Seton Hall University and her DNP from the University of Iowa. She maintains a practice in East Orange, New Jersey, in addition to her academic appointment. Her clinical expertise is in the care of the adult patient with cardiovascular disease, specializing in hypertension, lipid disorders, and cardiac arrhythmias. Additional interests include the advancement of the nurse practitioner role in today s health care environment, and encouraging and teaching nurse practitioners role development, advancement, and the importance of staying politically active. Mary Ellen E. Roberts, DNP, RN, APNC, FAANP, FAAN, has no conflicts of interest to disclose. 2

3 ABBREVIATIONS Learning Objectives Upon completion of this activity, the participant should be able to: 1. Summarize updates to JNC 8 hypertension treatment guidelines and their relevance to helping patients achieve better blood pressure control. 2. Develop safe and effective tailored therapeutic regimens for hypertension (taking into account patient comorbidities, side effect profiles of agents, and appropriate combinations of agents). 3. Use adherence-promoting strategies to empower patients and caregivers and improve outcomes. Target Audience This group lecture program has been designed for nurse practitioners involved in the care of patients with hypertension. Credit Statement This program is approved for 1.0 contact hour of continuing education (which includes 0.25 hour of pharmacology) by the American Association of Nurse Practitioners. Program ID This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards. The following abbreviations appear in the slides and the pages of this workbook. ACE ACE-I ABPM ADA ARB BB BMI BP CAD CCB CHD CHF CKD CPAP CV CVD DASH DBP ESC ESH/ESC ESRD GERD HBPM HF HTN ICD JNC JNC 8 K LVEF LVH MI NHANES NICE NSAIDs PMH PSH RAAS RCTs SBP angiotensin-converting enzyme ACE inhibitor Ambulatory Blood Pressure Measurement American Diabetes Association angiotensin II receptor blocker beta blocker body mass index blood pressure coronary artery disease calcium channel blocker coronary heart disease chronic heart failure chronic kidney disease continuous positive airway pressure cardiovascular cardiovascular disease Dietary Approaches to Stop Hypertension diastolic blood pressure European Society of Cardiology European Society of Hypertension and the European Society of Cardiology end stage renal disease gastroesophageal reflux disease Home Blood Pressure Monitoring heart failure hypertension implantable cardioverter defibrillator Joint National Committee The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure potassium left ventricular ejection fraction left ventricular hypertrophy myocardial infarction National Health and Nutrition Examination Survey National Institute for Health and Care Excellence (UK) nonsteroidal anti-inflammatory drugs past medical history past surgical history renin angiotensin aldosterone system randomized clinical trials systolic blood pressure 3

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24 Appendix 1, Management Algorithm, JNC 8 APPENDICES James PA, Oparil S, Carter BL, et al 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 Dec 18. doi: /jama [Epub ahead of print] 24

25 Appendix 2, Table 4, JNC 8 James PA, Oparil S, Carter BL, et al 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 Dec 18. doi: /jama [Epub ahead of print] Appendix 3, Table 5, JNC 8 James PA, Oparil S, Carter BL, et al 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 Dec 18. doi: /jama [Epub ahead of print] 25

26 REFERENCES Resources Many online resources are available to clinicians who treat patients with cardiovascular conditions. Resources from the National Institutes of Health (NIH) National Heart, Lung, and Blood Institute (NHLBI) Offers a wide variety of resources for clinicians and patients. JNC 8 Guidelines ames+pa+jnc+8+guidelines Other National Resources Million Hearts pressure.html Million Hearts is a national initiative that was launched by the Department of Health and Human Services in September 2011 to prevent 1 million heart attacks and strokes by Sample HTN protocols and custom protocol templates available November Centers for Disease Control and Prevention Agency for Healthcare Research and Quality Sign up for weekly evidence-based practice updates. Institute of Medicine of the National Academies Additional Cardiology Resources American College of Cardiology American Heart Association Heart Rhythm Society (previously NASPE) Heart Failure Society of America American Association of Heart Failure Nurses Preventive Cardiovascular Nursing Association WomenHeart American Diabetes Association. Summary of revisions for the 2013 clinical practice recommendations. Diabetes Care. 2013;36:S3. Aronow WS, Fleg JL, Pepine CJ, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2011;57(20): Brook RD, Appel LJ, Rubenfire M, et al. Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the American Heart Association. Hypertension. 2013;61(6): Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population: results from the Third National Health and Nutrition Examination Survey, Hypertension. 1995;25(3): Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation. 2008;117(25):e510-e526. Centers for Disease Control and Prevention. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Health and Human Services; s/mh_smbp.pdf James PA, Oparil S, Carter BL, et al 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 Dec 18. [Epub ahead of print] Davis, LL. How to implement home BP monitoring. July 1, how-to-implement-home-bpmonitoring/article/206808/ Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics 2014 update: a report from the american heart association. Circulation Dec 18. [Epub ahead of print]. Mancia G, Fagard R, Narkiewicz K, et al ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7): Martin SS, Metkus TS, Horne A, et al. Waiting for the National Cholesterol Education Program Adult Treatment Panel IV Guidelines, and in the meantime, some challenges and recommendations. Am J Cardiol. 2012;110(2): NHLBI Clinical Practice Guidelines and Reports in Development: guidelines/indevelop.htm Pickering TG, Hall JE, Appel LJ, et al. Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension. 2005;45(1): Pickering TG, Miller NH, Ogedegbe G, et al. Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008;52(1): Stamler R. Implications of the IN- TERSALT study. Hypertension. 1991:17(1): Upadhyay A, Earley A, Haynes SM, Uhlig K. Systematic review: blood pressure target in chronic kidney disease and proteinuria as an effect modifier. Ann Intern Med. 2011;154(8): Viera AJ, Hinderliter AL. Evaluation and management of the patient with difficult-to-control or resistant hypertension. Am Fam Physician. 2009;79(10): Whelton PK, He J, Appel LJ, et al. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA. 2002;288(15):

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