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VHA/DOD CLINICAL PRACTICE GUIDELINE FOR DIAGNOSIS AND MANAGEMENT OF HYPERTENSION IN THE PRIMARY CARE SETTING Veterans Health Administration Department of Defense Page 2 Prepared by: The Hypertension Workgroup with support from: The Office of Performance and Quality, VHA Headquarters, Washington, DC & Quality Management Directorate, United States Army MEDCOM & The External Peer Review Program Contractor and Subcontractor: West Virginia Medical Institute, Inc. Birch & Davis Associates, Inc. Contract number: V101(93)P-1633 May 1999 Version 1.0 Page 3 CLINICAL PRACTICE GUIDELINE FOR DIAGNOSIS AND MANAGEMENT OF HYPERTENSION IN THE PRIMARY CARE SETTING TABLE OF CONTENTS Page 4 VHA/DoD Clinical ...

__ STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF HEALTH SERVICES Arnold Schwarzenegger, Governor Kimberly Belshé, Secretary Sandra Shewry, Director Hypertension Disease Deaths in California, 1999-2002 By Daniel H. Cox Introduction Hypertension disease, also known as essential (primary) hypertension and hypertensive renal disease or high blood pressure, is a leading cause of death in the United States and in California. Hypertension disease increases the risk for heart disease and stroke, two other leading causes of death. Approximately one in four American adults have hypertension disease and more than 31 percent of those affected are unaware of their condition. 1 In 2002 there were 20,261 hypertension disease deaths in the United States; 2,330 of those deaths occurred in California. 2 ...

Tulane University Office of Technology Transfer and Business Development 1430 Tulane Ave TB-32 New Orleans, LA 70112 504-988-6962 / 988-2473 fax Marker for Essential Hypertension Jules Puschett BACKGROUND Elevated blood pressure or hypertension has long been recognized as a health problem and is frequently asymptomatic. Essential hypertension can be divided into two broad categories, volume expansion hypertension and vasoconstriction hypertension . Volume expansion hypertension accounts for 40% of the hypertensive population and has important implications in certain demographic groups such as African-Americans, the obese, and the elderly. It could also have implications for diabetics in their disease process. DESCRIPTION OF THE INVENTION Tulane researchers have conducted studies on etiologic factors in forms of hypertension and identified a "marker" ...

L IFESTYLE M ODIFICATIONS Not at Goal Blood Pressure (<140/90 mmHg) (<130/80 mmHg for patients with diabetes or chronic kidney disease) Without Compelling Indications With Compelling Indications I NITIAL D RUG C HOICES Stage 1 Hypertension (SBP 140–159 or DBP 90–99 mmHg) Thiazide-type diuretics for most. May consider ACEI, A2RA, BB, CCB, or com- bination. Stage 2 Hypertension (SBP >160 or DBP >100 mmHg) Two-drug com- bination for most (usually thiazide- type diuretic and ACEI, or A2RA, or BB, or CCB) Drug(s) for the Compelling Indications (See Table on Com- pelling Indications for Drug Classes based on Comorbid Conditions [Table 2]) Other antihypertensive drugs (diuretics, ACEI, ...

335 Journal of Manipulative and Physiological Therapeutics Volume 24 • Number 5 • June 2001 0161-4754/2001/$35.00 + 0 76/1/115263 © 2001 JMPT Medically Supervised Water-only Fasting in the Treatment of Hypertension Alan Goldhamer, DC, a Douglas Lisle, PhD, b Banoo Parpia, PhD, c Scott V. Anderson, MD, d and T. Colin Campbell, PhD e INTRODUCTION Hypertension -related diseases are the most common causes of morbidity and mortality among industrially advanced soci- eties. 1 Each year in the United States, there are 500,000 victims of stroke. Hypertension is the major cause in these incidents, one third of which are fatal. 2 Hypertension also is thought to be the most easily controlled, preventable factor in congestive heart failure, a disease involved ...

BRITISH HYPERTENSION SOCIETY GUIDELINES Guidelines for management of hypertension : report of the fourth working party of the British Hypertension Society, 2004—BHS IV B Williams 1 , NR Poulter 2 , MJ Brown 3 , M Davis 4 , GT McInnes 5 , JF Potter 6 , PS Sever 2 and S McG Thom 2 1 Department of Cardiovascular Sciences, Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, Leicester, UK; 2 International Centre for Circulatory Health, Imperial College London & St Mary’s Hospital, London, UK; 3 Clinical Pharmacology Unit, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK; 4 Moorfield House Surgery, Garforth, Leeds, UK; 5 Section of Clinical Pharmacology ...

© Crown Copyright 2003 1 GMS CONTRACT DATA ENTRY FOR HYPERTENSION 2. Click on Encounter 1. Highlight the patient’s name and press F8 3. Click on Care Management 4. Click on SPICE button Page 2 GMS CONTRACT DATA ENTRY FOR HYPERTENSION QUICK GUIDE © Crown Copyright 2003 2 The 1 st SPICE Index is displayed: The SPICE Hypertension screen is displayed: 5. Click Hypertension button 6. Enter data in some or all of the fields (as Displays certification logo and details of form designer Displays information about the disease area Returns to 1 st SPICE Index required) 7. Click on Recall button to set a recall (steps 7-13 ...

0-14 15-17 18-24 25-34 35-44 45-54 55-64 65-74 75+ Gender Male * * 1,217 3,576 11,473 20,522 23,459 16,691 15,300 92,335 Female * * 1,121 2,363 8,819 16,112 23,999 18,683 25,795 96,971 Ethnicity/Race Caucasian * * 590 1,165 3,366 6,670 12,126 7,678 9,139 40,794 Hawaiian * * * 987 5,138 7,040 9,058 4,831 2,950 30,615 Chinese -- -- -- * 1,136 3,378 2,122 * * 12,666 Filipino -- -- 511 1,414 4,183 7,931 8,644 5,919 5,230 33,832 Japanese * -- * 938 4,143 9,638 12,641 12,696 17,308 ...

0-14 15-17 18-24 25-34 35-44 45-54 55-64 65-74 75+ Gender Male 166* 410 1,358 3,891 10,531 17,747 17,034 14,797 12,255 78,189 Female 256* 13* 744 1,693 5,752 16,231 13,856 18,331 18,984 75,860 Ethnicity/Race Caucasian 167* -- 371* 711 1,623 6,919 6,430 6,063 5,550 27,834 Hawaiian 155* 102* 598 1,550 4,485 5,323 6,084 4,624 2,589 25,510 Chinese -- -- -- 31* 891 1,432 1,895 2,144 3,794 10,187 Filipino 58* 145* 209* 843 2,977 5,906 4,904 4,715 3,843 23,600 Japanese 43* 178* 265* 868 4,604 ...

Part I: Detection and Diagnosis of Hypertension Scope This guideline applies to the detection and diagnosis of hypertension (HT) in non-pregnant adults (aged 19 years and older). This guideline is to be used with “Part II: Treatment of Essential Hypertension ”. Hypertension in each category is defined by an elevation of the systolic or diastolic threshold or both. R ECOMMENDATION 1: Recommended technique Details of proper technique and equipment are included on page 2. Blood pressure (BP) measurement should be rigorous in those patients who: • have known or newly detected elevated BP; • have cardiovascular target organ damage;* • have other risk factors; or • are receiving antihypertensive therapy. R ECOMMENDATION 2: Follow a plan Blood pressure is noted to be > 140/90 • take at least two readings ...

Eastern Journal of Medicine 6 (1): 22-25, 2001 Erkoç et al. 22 Objective: The aim was to investigate the prevalence of hypertension in Van. Method: A total of 2010 subjects (586 male, mean age: 44.8 ± 14.9; 1424 female, mean age: 39.1 ± 14.1) between the ages of 20-74, were sampled from a target population of 315,866 according to systematic sampling technique. Blood pressure of each participant was measured by using Erka ® sphygmomanometer for two times with a 3 minutes interval by a physician and an average was obtained. Results: Hypertension prevalence was 34.9 % (males: 33.3 %, females: 35.5 %, p> 0.05) according to 140/90 mmHg criterium and 19.1 % (males: 14.5 %, females: 21.0 %, p < 0.001) according to 160/95 mmHg criterium. Mean systolic and diastolic blood pressures were 129.97± 27.78 mmHg (95% CI:128.7, ...

HYPERTENSION National programme for control and management at primary level Page 2 1 INTRO- DUCTION Hypertension is a major public health prob- lem in virtually all parts of the world, as well as in South Africa. A consistent blood pressure above 140/90 mmHg carries an increased risk for hyper- tension-associated diseases such as strokes and heart attacks. The World Health Organi- sation (WHO) defines being hypertensive as having a blood pressure higher than 160/95 mmHg. The health risk a given level of blood pressure presents is magnified by risk factors: e.g. obesity, unhealthy nutrition, diabetes mellitus, excessive alcohol intake, physical inactivity, and smoking. These risk factors are primarily the result of following an unhealthy lifestyle and emphasise the societal character of the problem. Effective ...

277 INTRODUCTION Pulmonary hypertension is a progressive disease that ultimately leads to right-ventricular failure and death. It is characterized by an elevated pulmonary artery pressure and pulmonary vascular resistance. The incidence of primary pulmonary hypertension (PPH) is estimated to be 1–2/ 1000 000/year and approximately 6% appear to be familial. There is a preponderance of females among PPH patients with a ratio of female to male varying between 1.7 and 3.5:1. DEFINITION Pulmonary hypertension is defined as an elevated mean pulmonary artery pressure of 25 mmHg or greater at rest or 30 mmHg with exercise. In 1998, the World Health Organization set out new guidelines for the re-classification of pulmonary hypertension (Boxes 19.1 & 19.2). PATHOLOGY Pulmonary arteriopathy is characterized by medial hypertrophy, intimal proliferation, concentric ...

P & T D IGEST A PEER-REVIEWED COMPENDIUM OF FORMULARY CONSIDERATIONS • Prevalence and economic implications • Summary of JNC-7 guidelines • Trials underlying JNC-7 guidelines • Implications of uncontrolled hypertension • Drug-therapy review • Recommendations for combination therapy • NCQA standards and quality measurement • Adherence to therapy • Formulary status of antihypertensive agents Vol.28,No.8 August 2003 S U P P L E M E N T T O H YPERTENSION Continuing education credit for physicians and pharmacists is sponsored byThe Chatham Institute This program is supported by an unrestricted educational grant from AstraZeneca Pharmacy and Therapeutics A Peer-Reviewed Journal for Managed Care and Hospital Formulary ...

OB-Chronic Hypertension 1 of 6 OBSTETRICAL GUIDELINE Chronic Hypertension Drafted: 06/30/03 Peer Reviewed: 04/29/04 Finalized: 05/27/04 I. Definition, Assessment, and Diagnosis: A. Definition: 1. Chronic hypertension is defined as hypertension (blood pressure > 140/90) present before the pregnancy. 2. Diagnosed before the 20 th week of gestation of pregnancy. 3. Persists more than 12 weeks postpartum. B. Assessment: Documented history of high blood pressure pre- pregnancy. Persistent elevation of blood pressure (at least 140/90mm Hg) on two separate occasions more than 24 hours apart before the 20 th week of gestation. 1. Other changes suggestive in the presence of chronic hypertension : a. Retinal changes on funduscopic examination b. Cardiac enlargement on chest x-ray and ECG c. Presence ...

Issue date: August 2004 Quick reference guide Hypertension – management of hypertension in adults in primary care Clinical Guideline 18 Developed by the Newcastle Guideline Development and Research Unit Page 2 This guidance is written in the following context. This guidance represents the view of the Institute, which was arrived at after careful consideration of the evidence available. Health professionals are expected to take it fully into account when exercising their clinical judgement. The guidance does not, however, override the individual responsibility of health professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. National Institute for Clinical Excellence MidCity Place 71 High Holborn London WC1V ...

RESEARCH COMMUNICATIONS CURRENT SCIENCE, VOL. 87, NO. 8, 25 OCTOBER 2004 Dermal ulcers and hypertension in salt workers Kripa Ram Haldiya 1, *, Murli L. Mathur 1 , Raman Sachdev 1 and Habibulla N. Saiyed 2 1 Desert Medicine Research Centre (ICMR), Jodhpur 342 005, India 2 National Institute of Occupational Health (ICMR), Meghani Nagar, Ahmedabad 380 816, India In the process of salt manufacture, brine rich in salt is filled in broad pans exposed to direct sunlight. Brine workers keep their feet in the brine while working in these pans. They frequently have traumatic ulcers on their feet and hands. The aim of the present communica- tion was to find out if prevalence of hypertension and blood pressure in brine workers was affected by the presence of ulcers ...

Pharmacogenomics Protocol #030199 – Drs. O’Connor and Bhatnagar Original -6/5/03 Revision- 6/8/04 Pharmacogenomics and Hypertension Draft Protocols June 17, 2004 (1) Mail Recruitment • HTN Clinical lab (2) Consent and Sample Returned • HTN Clinical lab (3) DNA Extraction and Quantification • Stein HTN lab (4) DNA Prep for Genotyping • Genomics Core/ Stein HTN lab ( 5) Genotyping: Results • Bioinfomatics core Page 2 Pharmacogenomics Protocol #030199 – Drs. O’Connor and Bhatnagar Original -6/5/03 Revision- 6/8/04 (1) Protocol for Mail Recruitment Pharmacogenomics #030199 Drs. O’Connor and Bhatnagar An electronic system needs to be developed to track the following steps. Each initial mailed packet should contain the following: • Revised (5/04) Recruitment letter • Revised (5/04) Consent ...

Hypertension in Children Selected excerpts from “The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents,” Pediatrics, Vol. 114, No. 2, August 2004 Definition of Hypertension • Hypertension is defined as average SBP and/or diastolic BP (DBP) that 95th percentile for gender, age, and height on =3 occasions. • Prehypertension in children is defined as average SBP or DBP levels that are =90th percentile but <95th percentile; as with adults, adolescents with BP levels =120/80 mm Hg should also be considered prehypertensive. • A patient with BP levels >95th percentile in a physician’s office or clinic, who is normotensive outside a clinical setting, has “white-coat hypertension .” Ambulatory BP monitoring (ABPM) is usually required to make this diagnosis. THERAPEUTIC LIFESTYLE CHANGES • Weight reduction ...

EFFECTIVENESS EFFECTIVENESS Matters Matters NHS CENTRE FOR REVIEWS AND DISSEMINATION Effectiveness Matters is based upon the findings of recent high quality systematic reviews. In this issue we explore the evidence for the drug treatment of hypertension in older people with the aim of preventing cardiovascular disease. Vol 4, Issue 2, October 1999 s Hypertension is very common, occurring in over 50% of older people, and is a major risk factor for stroke and ischaemic heart disease. s Drug treatment of hypertension in older people saves lives and prevents unnecessary morbidity. s Treating isolated systolic hypertension also saves lives. s There is strong evidence to support the use of diuretics as first line agents. s Antihypertensive treatments are most ...

Hypertension Guideline 2004: A Brief Overview Peter A. Glassman MBBS, MSc Staff Physician, VA Greater Los Angeles Member, HTN Faculty Advisory Committee Page 2 Key Elements “ Speed to Target ” S creen P revent E ncourage E valuate D rug(s) Therapy T itrate O rganize T ARGET Page 3 SPEED Page 4 Page 5 Screen Now Assess blood pressure in adults Page 6 Screen Annually Incidence Rises Over Time 1976-98 Cumulative Incidence of HTN in Women and Men Aged 65 Years 1976 1976 - - 98 Cumulative Incidence of HTN 98 Cumulative Incidence of HTN in Women and Men Aged 65 Years in Women and Men Aged 65 Years JAMA.2002;287:1003 ...

Hypertension HEALTHY HEARTS SERIES: BLOOD PRESSURE Who is at risk? Proportion of Idahoans who’ve been told by a health professional they have high blood pressure*: Age 65 and over: 49% Age 55 and over: 42% Less than high school education: 32% Household income less than $20,000: 29% Adult men: 24% Adult women: 23% Hispanic adults: 18% Ages 18 to 24: 8% High Blood Pressure: New Guidelines Cardiovascular disease, the leading cause of death in Idaho In 1996, 2,359 persons in Idaho died of diseases of the heart and 708 persons died of cerebrovascular disease. Such diseases often result from the complications of high blood pressure. • From 1993-1995, the age-adjusted rate of cerebrovascular diseases, which includes stroke, ...

Topic: Renovascular Hypertension Hypertension affects an estimated 10 percent to 25 percent of the U.S. population. Of these, the great majority have primary elevation of blood pressure, which can be ameliorated with pharma- cological treatment. A subset of patients — an estimated 3 percent to 8 percent — have sec- ondary hypertension attributable to renovascular disease caused by narrowing of the renal artery. 1-2 Diminished perfusion to the kidney results in increased renin secretion and production of angiotensin II, leading to systemic vasoconstriction and retention of salt and water. Renovascular hyper- tension may be present when systemic blood pres- sure is normal. Renovascular hypertension has emerged as a major cause of end-stage renal disease, especially in the elderly. As the U.S. population ages, the num- ber of individuals with atherosclerotic ...

Guidelines are designed to assist clinicians by providing a framework for the evaluation and treatment of patients. These guidelines outline the preferred approach for most patients. They are not intended to replace a clinician's judgment or to establish a protocol for all patients. It is understood that some patients will not fit the clinical condition contemplated by a guideline and that a guide- line will rarely establish the only appropriate approach to a problem. The purpose of treating hypertension is to reduce the incidence of stroke, MI, renal failure and heart failure. Unless contraindicated or there is a compelling indication to use other medication, low dose diuretic therapy should be used as first or second line therapy. 1. ESTABLISHING THE DIAGNOSIS The diagnosis of hypertension should be based on the confirmation of elevated readings on two or more subsequent visits to the physician or health ...

Introduction Obesity in the United States has reached epidemic proportions and its prevalence continues to rise as Americans become less physically active and more sedentary. Among adolescents, African Americans exhibit the highest rates of obesity. Based on data from the 1999-2000 National Health and Nutritional Examination Survey (NHANES III) it is estimated that the prevalence of obesity in African American adolescents (23.6%) is significantly higher than their non-Hispanic white counterparts (12.7%) and has increased by 13.4% between 1988- 1994 and 1999-2000. As obesity among African Americans adolescents continues to increase the rate of metabolic abnormalities, cardiovascular disease and type II diabetes among this group will mimic this increasing trend. Not only is obesity a known independent risk factor for the development of cardiovascular disease (CVD), but it tends to cluster with other ...

MJA Vol 176 17 June 2002 571 EDITORIALS indicated widespread damage and evidence of increased endothelial activity ranging from scarring through to nuclear atypia. There are important lessons to be learned. Exposure of the thyroid gland to any irradiation requires lifelong supervi- sion and introspection. This should include high-resolution ultrasound. The extent of thyroid exposure to radiation may be arcane and not recalled when the highlight of the history is focused on areas away from the gland. Most radiation oncology units in Australia have follow-up facilities, but the duration of follow-up is not uniform. Moreover, patients travel and disperse, so their supervision will be most likely carried out by doctors with less experience of such patients. In this regard the American Thyroid Association publishes an excellent information sheet for patients. 4 ...

564 MJA Vol 178 2 June 2003 CLINICAL UPDATE The Medical Journal of Australia ISSN: 0025-729X 2 June 2003 178 12 564-567 ©The Medical Journal of Australia 2003 www.mja.com.au Clinical Update P ULMONARY ARTERIAL HYPERTENSION (PAH) is gener- ally considered a rare and rapidly lethal condition with poor prognosis and few or no treatment options. 1,2 However, PAH is a generic term that includes elevated pulmonary vascular resistance due to a wide range of causes (Box 1). 3 PAH is defined as a mean pulmonary arterial pressure of >25 mmHg at rest and >30 mmHg with exercise. Primary pulmonary hypertension has an estimated incidence of 2 per million population (possibly higher), with PAH associated with other diseases showing a higher incidence. 3 PAH is often not detected until the late and highly ...