Essential Hypertension

[2014 update]

Introduction to this self-study CME activity

Purpose

Approximately 25% of adults in the United States adults have elevated hypertension.  Half of these people have no medication prescribed, and half of the people on medication are not controlled. Uncontrolled hypertension results in end stage organ damage, which leads to significant mortality and morbidity. The purpose of this educational activity is to help clinicians understand and implement clinical care to:

(1) accurately diagnose hypertension,
(2) improve blood pressure (BP) control,
(3) decrease hypertension-related morbidity and mortality,
(4) encourage patient’s self-involvement,
(5) provide appropriate education and follow-up, and
(6) provide cost-effective care.

New aspects of care addressed in this update include:

  • Options for preferred initial drug treatment have expanded beyond thiazide diuretics to include calcium channel blockers and ACE inhibitors.
  • Earlier initiation of dual antihypertensive medications is emphasized, particularly with calcium channel blocker and renin/angiotensin system inhibitor (e.g., ACE inhibitor).
  • Systolic and diastolic BP control for patients with diabetes and chronic kidney disease is less strict, with the target systolic BP now < 140 mmHg (instead of < 130) and diastolic BP < 90 mmHg, although diastolic BP < 80 mmHg may still be considered.

 Key aspects of care are:

  • Diagnosis is best using mean BP levels over several visits, and careful calibration of the BP monitor.
  • Target for BP therapy is:

–  < 140/90 mm Hg  for patients

-  Age 18 to 59 years without diabetes or renal insufficiency

-  Age ≥ 18 years with diabetes, renal disease, cardiovascular disease or cerebrovascular disease

–  < 150/90 for patients aged 60 years or older without diabetes, renal disease, cardiovascular disease or cerebrovascular disease.

  • Thiazide diuretics, calcium channel blockers and ACE inhibitors are generally the preferred initial drug treatment.
  • Add second and third agents as needed.  The combination of calcium channel blocker and renin/angiotensin system inhibitor (e.g., ACE inhibitors, angiotensin receptor blocker) is increasingly viewed as the drug combination of choice.
  • Patient education and self-management are fundamental to successful therapy.

Objectives

Participants in this CME activity will understand and be able to implement evidence-based cost-effective clinical strategies for the diagnosis and treatment of hypertension in adults over age 18.

Audience

This self-study activity is appropriate for primary care clinicians and other health care providers who diagnose and treat hypertension in adults.

Authors

Team Leaders

  • Masahito Jimbo, MD
    Family Medicine

Team Members

  • Mark W Ealovega, MD
    General Medicine
  • Michael P Dorsch, PharmD
    Pharmacy
  • R Van Harrison, PhD
    Medical Education
  • Kenneth A Jamerson, MD
    Cardiovascular Medicine

Author Disclosures

Neither the team lead, the team members, nor the consultants have financial relationships with commercial companies whose products are discussed in this CME activity.
Masahito Jimbo, MD
(None)
Mark W Ealovega, MD
(None)
Michael P Dorsch, PharmD
Speakers Bureau
Astra/Zeneca, Boehringer Ingelheim, Jansen
R Van Harrison, PhD
(None)
Kenneth Jamerson, MD
Research support, Consultant, Speakers Bureau
Novartis, Astra/Zeneca, Boehringer Ingelheim, Novartis, Takeda, Daiich Sankyo

Other Acknowledgements

UMHS Guidelines Oversight Team

  • Grant M Greenberg, MD, MA, MHSA
  • R Van Harrison, PhD

Literature Search Services

  • Taubman Medical Library

Production of Internet Format and Website Maintenance

  • Ellen Patrick-Dunlavey, MA

CME Accreditation and Credit Designation

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This CME activity was prepared for release in May 2014. Credit may be awarded for a maximum of three years from its release date, specifically from May 2014 through April 2017. The activity was reviewed for currency of content in September 2017 and availability of credit extended through August 2020. Continuation of credit from that date depends on a thorough review of the content currency and accuracy.

Method of Participation

  1. View the web pages. You may print the self-study text to read off-line.
  2. Complete the on-line learning assessment test with a score of 70% or higher.  After you initially take the test, the test will be immediately electronically scored. 
    If fewer than 70% of the questions are answered correctly, the questions that were not answered correctly will be noted in red.  Review the CME content related to those topics and retake the test.
    If 70% or more of the questions are answered correctly, the correct and incorrect answers for all questions will be shown along with explanations of the basis for the correct answer.  The link to register and receive credit is shown at the end of the items and explanations. 
  3. Complete the electronic credit request and activity evaluation.  An electronic certificate of participation will be provided immediately.
  4. Print the certificate of participation for your personal records.