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JNC – 8 Jim Hoehns, Pharm.D .

JNC – 8 Jim Hoehns, Pharm.D . 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

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JNC – 8 Jim Hoehns, Pharm.D .

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  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

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