1 / 22

Impact of Antihypertensive Drug Therapy on Health Outcomes in Adults with Hypertension

This evidence review examines randomized controlled trials involving adults aged 18 and older with hypertension, focusing on various health outcomes associated with different antihypertensive treatments. Key questions addressed include the effectiveness of initiating therapy at specific BP thresholds, the influence of treatment goals on health outcomes, and the comparative benefits and harms of various antihypertensive drug classes. Findings suggest tailored treatment strategies are crucial for improving outcomes such as CVD-related mortality, hospitalization, and renal function decline.

serena
Télécharger la présentation

Impact of Antihypertensive Drug Therapy on Health Outcomes in Adults with Hypertension

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. JNC – 8Jim Hoehns, Pharm.D.

  2. Evidence Review • Randomized controlled trials • Adults ≥ 18 years old with hypertension • N >100 • Duration: ≥ 1 year • Outcomes • Mortality, CVD related-mortality, CKD-related mortality • MI, HF, hospitalization-HF • Coronary or other revascularization • ESRD • KF resulting in dialysis or transplantation, doubling of Cr value, halving of GFR

  3. 3 Questions • In adults with HTN, • Does initiating antihypertensive drug therapy at specific BP thresholds improve health outcomes? • Does treatment with antihypertensive drug therapy to a specified goal lead to improvement in health outcomes? • Do various antihypertensive drugs or drug classes differ in comparative benefits and harms on specific health outcomes?

  4. Question 1 • 45 y.o. white female • Hx: HTN, hyperlipidemia, MDD • Meds: Atorvastatin 20mg QD, Fluoxetine 20mg QD • BP: 150/96, HR: 73 Treatment: • Lisinopril 10mg QD • Amlodipine 5mg • HCTZ 12.5-25mg QD • MetoprololBID 10

  5. Question 2 •64 y.o. white male • Hx: CKD, HTN, hyperlipidemia • Meds: simvastatin 20mg QD, ASA 81mg QD, lisinopril 20mg QD • Labs: Cr = 1.9, K+ = 4.8, Est Clcr = 38 ml/min • BP: 152/94, HR: 68 Treatment: • HCTZ 12.5-25mg QD • Amlodipine 5mg QD • Losartan 50mg QD • Increase lisinopril to 40mg QD 10

  6. Question 3 •56 y.o. black male • Hx: diabetes, HTN, obstructive sleep apnea • Meds: metformin 1000mg BID, ASA 81mg QD, Gluctotrol XL 10mg QD • Labs: Cr = 1.0 • BP: 148/88, HR: 70 • Treatment: • lisinopril 10mg QD • losartan 50mg QD • HCTZ 12.5-25mg QD • Furosemide 20mg QD 10

  7. Question 4 •67 y.o. white male •Hx: HTN, DM, hyperlipidemia, GERD, BPH •Meds: finasteride 5mg QD, Zocor 80mg QD, terazosin 10mg QD, glimepride 4mg QD, Actos 45mg QD, lisinopril 10mg QD, metformin XR 2000mg/d, ASA 81mg QD •Labs: Cr: 1.2, microalbumin 10mg/L, K+ = 4.3 •BP: 160/88,HR: 57 Treatment • HCTZ 12.5-25mg QD • Hydralazine 25mg BID • DiltiazemXR 180mg QD • Increase lisinopril to 20mg QD 10

  8. Question 5 •77 y.o. female •Hx: HTN, osteoporosis, angina, GERD •Meds: Reclast 5mg Qyear, Prilosec 40mg QD, Toprol XL 100mg QD, ASA, lisinopril/HCTZ 20/25mg QD •BP: 169/66, HR: 57, weight: 100 lbs, Cr = 0.3, K+ = 4.2 Treatment: • Terazosin • Amlodipine • Hydralazine • Furosemide 10

  9. Question 6 •78 y.o. female •Hx: Afib (c/o palpitations), HTN •Meds: warfarin, metoprolol 100mg BID, losartan 50mg QD •BP: 154/82 HR: 90 Treatment • Amlodipine • Diltiazem XR • Spironolactone • Furosemide 10

  10. Question 7 •66 y.o. black male • Hx: HTN, s/p MI 2 months ago, hyperlipidemia • Meds: atorvastatin 20mg QD, ASA 81mg QD, Plavix 75mg QD, HCTZ 25mg QD, metoprolol 100mg BID • BP: 152/92, HR: 62 Treatment • Amlodipine • Lisinopril • DiltiazemXR • Furosemide 10

  11. Question 8 •66 y.o. male •Hx: CKD, HTN, diabetes, PAD, hypothyroidism, hyperlipidemia •Meds: ASA 81mg QD, Lantus + Humalog, levothyroxine 0.1mg QD, Crestor 20mg QD, lisinopril 20mg QD •Labs: Cr = 2.8, K+ = 4.8 •BP: 150/92, HR: 68 Treatment • atenolol • amlodipine • HCTZ • hydralazine 10

  12. Question 9 •70 y.o. male •Hx: HTN, LVH, GERD, TIA •Meds: Plavix 75mg QD, famotidine 20mg QD, HCTZ 25mg QD •BP: 154/86, HR: 70 Treatment • Metoprolol • Lisinopril • Amlodipine • Spironolactone 10

  13. Question 10 •62 y.o. female •Hx: COPD, HTN, OA, obesity, CAD, occ symptomatic angina •Meds: Spiriva, Advair, ASA, Imdur 90mg QD, lisinopril 40mg QD, metoprolol XL 100mg QD, Nitrostat PRN •BP: 152/90, HR: 64 Treatment • HCTZ • valsartan • amlodipine • terazosin 10

  14. Summary • Age ≥ 60: goal BP is <150/90 • Age <60: goal BP is <140/90 • First line therapies • Thiazide, CCB’s, ACEI, ARB • Thiazide or CCB recommended over ACEI in blacks with diabetes • Beta-blockers: not recommended as first line therapy

More Related