5/14/2014 1

JNC8 and Current Guidelines for Blood Pressure and

Cholesterol Management

May 12, 2014

Presented by

Martha White, BSN MBA Technical Advisor Alliant GMCF

Objectives

► Review the current hypertension screening guidelines

► Discuss the JNC8 Hypertension Management Guidelines

► Review current cardiovascular risk assessment

► Discuss the 2013 ACC/AHA Hyperlipidemia Guidelines

Blood Pressure Basics

BP = CO x TPR

Blood Pressure = Cardiac Output x

Total Peripheral Resistance

CO = Stroke Volume x Heart

Rate = the amount of blood

pumped by the heart per

minute

TPR = the resistance to blood

flow through the vascular

system

Screening for Hypertension

► The U.S. Preventive Services Task Force (USPSTF) recommends screening for high blood pressure in adults aged 18 and older. (This is a grade "A" recommendation)

► Screen:

– Every 2 years - blood pressure less than 120/80 mm Hg

– Yearly - systolic 120 -139 mm Hg or diastolic 80 - 89 mm Hg

U.S. Preventive Services Task Force. Screening

for high blood pressure: U.S. Preventive Services

Task Force recommendation statement. Ann

Intern Med 2007:147-783-786.

Screening for Hypertension (cont’d)

► Hypertension diagnosed - 2 or more elevated readings on at least 2 visits over a period of 1 to several weeks

► Hypertension definition - adults with:

– Systolic - of 140 mmHg or higher or

– Diastolic - of 90 mmHg or higher

U.S. Preventive Services Task Force.

Screening for high blood pressure: U.S.

Preventive Services Task Force

recommendation statement. Ann Intern

Med 2007:147-783-786.

Factors for Selecting Therapy for Hypertension Management

► Age

► Race

► Diabetes

► Kidney disease

► Cost

► Side effect profile

Lifestyle Management For Hypertension

► DASH diet ► Reduce sodium

(<1500mg/day) ► Increase physical

activity – 3 to 4 sessions a week,

– lasting on average 40 minutes

per session, and

– involving moderate to vigorous

intensity physical activities

► Weight loss

► Stress management

► Reduction of alcohol intake – if consuming >20 drinks per week

Eckel RH, Jakicic JM, Ard JD, et al, 2013 AHA/ACC

Guideline on Lifestyle Management to Reduce

Cardiovascular Risk, doi:

0.1016/j.jacc.2013.11.003.

U.S. Preventive Services Task Force. Screening for

high blood pressure: U.S. Preventive Services Task

Force recommendation statement.

Ann Intern Med 2007:147-783-786.

JNC8 Hypertension Guideline Management Algorithm

Age 60,+

Age <60

Any Age

+DM, -CKD

Any Age

+CKD, +/-DM

BP Goal

<150/<90

BP Goal

<140/<90

BP Goal

<140/<90

BP Goal

<140/<90

Initiate thiazide or ACEI or

ARB or CCB, alone or

combo

Initiate thiazide or

CCB, alone or combo

Initiate ACEI or ARB, alone

or combo w/other class

Non-black Black All races

ACEI = ACE Inhibitor ARB = Angiotensin Receptor Blocker CCB = Calcium Channel Blocker

Adapted from James PA, et al. 2014 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. 2014;311(5):507-520. doi:10.1001/jama.2013.284427.

Cardiovascular Risk Assessment

► Risk factors – age, LDL-C, total and HDL-cholesterol, systolic BP, treatment status for hypertension, diabetes, current smoking status

► Applicable populations for risk calculator: – Non Hispanic Whites and African American

– Age 40-79 (10 year risk)

– Men and women

► Assess every 4-6 years if no ASCVD

Cardiovascular Risk Assessment

► Calculation of 10-year risk for first hard ASCVD event:

– Non-fatal myocardial infarction

– CHD death

– Fatal or non-fatal stroke

► Risk calculator not appropriate for those with

known ASCVD http://tools.cardiosource.org/ASCVD-Risk-Estimator/

Lifestyle Management for Reducing CV Risk

► Diet : – High in fruit and veggies, whole grains; low fat; limit

sweets – DASH diet

► Physical activity: – 3 to 4 sessions a week, lasting on average 40

minutes per session,

– involving moderate-to-vigorous intensity physical activity.

Eckel RH, Jakicic JM, Ard JD, et al, 2013 AHA/ACC

Guideline on Lifestyle Management to Reduce

Cardiovascular Risk, doi: 0.1016/j.jacc.2013.11.003.

2013 ACC/AHA Guidelines on the Treatment of Blood Cholesterol

Adapted from Stone NJ, et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the

American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013 Nov 12. [Epub ahead of print].

Clinical

ASCVD

LDL-C ≥

190 mg/dL

Diabetes

Age 40 - 75

High Intensity

10 Year

ASCVD Risk >

7.5% Age > 75

Moderate Intensity

No No

No

No

Yes

Yes

Yes

Yes

No

ASCVD = Atherosclerotic

cardiovascular disease

Yes

or

Yes

References

► U.S. Preventive Services Task Force. Screening for high blood pressure: U.S.

Preventive Services Task Force recommendation statement. Ann Intern

Med 2007:147-783-786.

► 2014 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. 2014;311(5):507-520.

doi:10.1001/jama.2013.284427

► 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular

Risk. A Report of the American College of Cardiology/American Heart

Association Task Force on Practice Guidelines. doi: 0.1016/j.jacc.2013.11.003

► ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce

Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College

of Cardiology/American Heart Association Task Force on Practice Guidelines.

Circulation. 2013 Nov 12. [Epub ahead of print].

► 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. A Report

of the American College of Cardiology/American Heart Association Task Force

on Practice Guidelines. 2013;01.cir.0000437741.48606.98published online

before print November 12 2013

This material was prepared by Alliant GMCF, the Medicare Quality Improvement Organization for Georgia, under contract with the Centers for Medicare & Medicaid Services

(CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 10SOW-GA-IHPC-14-30