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Hypertension Management for Specific Comorbid Diseases

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1. Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

of overweight and obesity 6 in the general population and in patients with increased cardiovascular risk, and a recent report from the Eighth Joint Na- tional Committee addressed the management of hypertension. 7 However, these guidelines did not specifically address the management of such comorbidities in patients with HF. Similarly, the most recent ACCF/AHA HF practice guidelines 8 in 2013 addressed the overall management of comorbidities in patients with HF in broad terms, but again, specific (...) Surgery and Anesthesia; Council on Cardiovascular and Stroke Nursing; Council on Hypertension; and Council on Quality and Outcomes Research Contributory risk and Management of Comorbidities of Hypertension, obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure A Scientific Statement From the American Heart Association © 2016 American Heart Association, Inc. Key Words: AHA Scientific Statements ? cardiovascular diseases ? comorbidity ? diabetes mellitus ? heart

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2016 American Heart Association

2. Hypertension Management for Specific Comorbid Diseases

Hypertension Management for Specific Comorbid Diseases Hypertension Management for Specific Comorbid Diseases Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse (...) Cancer Administration 4 Hypertension Management for Specific Comorbid Diseases Hypertension Management for Specific Comorbid Diseases Aka: Hypertension Management for Specific Comorbid Diseases , AntiHypertensives for Specific Comorbid Diseases From Related Chapters II. Management: Endocrine Conditions (with or without ) See or In black patients, use or instead s III. Management: Cardiovascular Conditions (Risk of sudden death) Central active agonists s s or (use with caution, CIBIS II, MERIT-HF

2018 FP Notebook

3. Hypertension in pregnancy: diagnosis and management

of birth 46 Antihypertensive treatment during the postnatal period, including during breastfeeding 48 Risk of recurrence of hypertensive disorders of pregnancy and long-term cardiovascular disease 49 Context 50 Hypertension in pregnancy: diagnosis and management (NG133) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 54Finding more information and resources 52 Update information 53 Hypertension in pregnancy (...) -eclampsia. [2010, amended 2019] [2010, amended 2019] Antiplatelet agents Antiplatelet agents 1.1.2 Advise pregnant women at high risk of pre-eclampsia to take 75–150 mg of aspirin [1] daily from 12 weeks until the birth of the baby. Women at high risk are those with any of the following: hypertensive disease during a previous pregnancy chronic kidney disease autoimmune disease such as systemic lupus erythematosus or antiphospholipid Hypertension in pregnancy: diagnosis and management (NG133) © NICE 2019

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

4. Hypertension management and renin-angiotensin-aldosterone system blockade in patients with diabetes, nephropathy and/or chronic kidney disease

Hypertension management and renin-angiotensin-aldosterone system blockade in patients with diabetes, nephropathy and/or chronic kidney disease Hypertension management and renin-angiotensin-aldosterone system blockade in patients with diabetes, nephropathy and/or chronic kidney disease Indranil Dasgupta DM FRCP , Debasish Banerjee MD FRCP , Tahseen A Chowdhury MD FRCP , Parijat De MD FRCP , Mona Wahba MA FRCP , Stephen Bain MD FRCP , Andrew Frankel MD FRCP , Damian Fogarty MD FRCP , Ana Pokrajac (...) in patients with diabetes and CKD stages 4 and 5 28 Management of hyperkalaemia with RAAS blockade in patients with diabetes and CKD stages 4 and 5 29 Non-pharmacological management of hypertension in patients with diabetes and CKD stages 4 and 5 30 4 Hypertension management in patients with diabetes and chronic kidney disease who are on dialysis (stage 5D) 31 Recommendations 32 Audit standards 32 Areas that require further research 33 Introduction 33 Blood pressure measurement in patients with diabetes

2017 Association of British Clinical Diabetologists

5. Choice of therapy for Adults With Hypertension Without Compelling Indications for Specific Agents

-acting calcium channel blocker (CCB) (Grade B). ‘Hypertension without compelling indications’ refers to patients with hypertension but without other identified comorbid conditions (such as diabetes mellitus or heart disease) that represent compelling indications for specific drug therapy. Randomized controlled trials have shown that antihypertensive therapy in these patients can reduce incidence of cardiovascular disease by 20% to 30%, depending on the specific outcome considered . Reduction (...) of hypertension-related complications continues to be paramount, and to depend more on the extent of blood pressure (BP) lowering than on choice of any specific drug class as first-line therapy for those patients without comorbid conditions which compel a specific drug class choice (such as diabetes mellitus, cardiac disease or renal disease) . Therefore, in the choice of antihypertensive drugs, consideration of BP control effectiveness supersedes consideration of ‘pleiotropic’ effects of the five major

2018 Hypertension Canada

6. ESC/ESH Management of Arterial Hypertension

, hypertension remains the major preventable cause of cardiovascular disease (CVD) and all-cause death globally and in our continent. These 2018 ESC/ESH Guidelines for the management of arterial hypertension are designed for adults with hypertension, i.e. aged ≥18 years. The purpose of the review and update of these Guidelines was to evaluate and incorporate new evidence into the Guideline recommendations. The specific aims of these Guidelines were to produce pragmatic recommendations to improve (...) therapy3090 8.21 Perioperative management of hypertension3090 9 Managing concomitant cardiovascular disease risk3091 9.1 Statins and lipid-lowering drugs3091 9.2 Antiplatelet therapy and anticoagulant therapy3091 9.3. Glucose-lowering drugs and blood pressure3092 10 Patient follow-up3092 10.1 Follow-up of hypertensive patients3092 10.2 Follow-up of subjects with high–normal blood pressure and white-coat hypertension3092 10.3 Elevated blood pressure at control visits3093 10.4 Improvement in blood pressure

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2018 European Society of Cardiology

7. Chronic obstructive pulmonary disease in over 16s: diagnosis and management

53 Oral prophylactic antibiotic therapy 54 Long-term oxygen therapy 55 Ambulatory and short-burst oxygen therapy 56 Managing pulmonary hypertension and cor pulmonale 57 Lung volume reduction procedures, bullectomy and lung transplantation 58 Risk factors for COPD exacerbations 59 Self-management, education and telehealth monitoring 60 Context 62 Finding more information and resources 63 Update information 64 Chronic obstructive pulmonary disease in over 16s: diagnosis and management (NG115) © (...) if sputum is persistently present and purulent Serial home peak flow measurements T o exclude asthma if diagnostic doubt remains Chronic obstructive pulmonary disease in over 16s: diagnosis and management (NG115) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 8 of 65Electrocardiogram (ECG) and serum natriuretic peptides* T o assess cardiac status if cardiac disease or pulmonary hypertension are suspected because

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

8. Pharmacological Management of Hypertension

availability) Direct acting vasodilators (e.g., hydralazine, minoxidil) Centrally acting antiadrenergic drugs (e.g., clonidine, methyldopa) (Strong for) The Work Group recommends against the use of alpha-adrenergic blockers as monotherapy, but this class of agents may be used as supplemental therapy or if warranted by comorbid conditions (e.g., symptomatic prostatic hypertrophy). ( Modified from 2004 VA/DoD HTN CPG .) ( Strong against ) Specific Populations In patients with hypertension and CKD (reduced (...) on a periodic discussion of the benefits and harms of specific BP targets with the patient. An SBP target of less than 140 mmHg is a reasonable goal for some patients with increased cardiovascular risk. The target depends on many factors unique to each patient, including comorbidity, medication burden, risk for adverse events, and cost. Clinicians should individually assess cardiovascular risk for patients. Generally, increased cardiovascular risk includes persons with known vascular disease, most patients

2017 National Guideline Clearinghouse (partial archive)

9. Clinical relevance of aortic stiffness in end-stage renal disease and diabetes: implication for hypertension management. (PubMed)

Clinical relevance of aortic stiffness in end-stage renal disease and diabetes: implication for hypertension management. : Evidence suggests that aortic stiffness may antedate and contribute initially to the development of hypertension and cardiovascular risk (CVR). In treated hypertensive patients, both diabetes and end-stage renal disease (ESRD) are comorbid conditions associated with increased aortic stiffness and high CVR. Thus, the pathophysiological relationship between aortic stiffness (...) , blood pressure (BP) and CVR may have clinical implication in the management of hypertension. In patients with diabetes or ESRD, aortic stiffness is a significant predictor of CVR, independently of BP control. The hallmark of accelerated aortic stiffening in these patients associates the presence of vascular calcification, which is considered as a time-dependent process. Aortic stiffness represents a marker of structural but also functional arterial damage associated with increased pressure

2018 Journal of Hypertension

10. Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE) guideline for the prevention and management of cardiovascular disease in primary care

Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE) guideline for the prevention and management of cardiovascular disease in primary care Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE) guideline for the prevention and management of cardiovascular disease in primary care: 2018 update | CMAJ Main menu User menu Search Search for this keyword Search for this keyword Guideline Canadian Cardiovascular Harmonized National Guidelines Endeavour (C (...) -CHANGE) guideline for the prevention and management of cardiovascular disease in primary care: 2018 update Sheldon W. Tobe , James A. Stone , Todd Anderson , Simon Bacon , Alice Y.Y. Cheng , Stella S. Daskalopoulou , Justin A. Ezekowitz , Jean C. Gregoire , Gord Gubitz , Rahul Jain , Karim Keshavjee , Patty Lindsay , Mary L’Abbe , David C.W. Lau , Lawrence A. Leiter , Eileen O’Meara , Glen J. Pearson , Doreen M. Rabi , Diana Sherifali , Peter Selby , Jack V. Tu , Sean Wharton , Kimberly M. Walker

2018 CPG Infobase

11. Management of Cardiovascular Diseases during Pregnancy

3.10.4 In vitro fertilization 3181 3.11 Recommendations 3182 4. Congenital heart disease and pulmonary hypertension 3182 4.1 Introduction 3182 4.2 Pulmonary hypertension and Eisenmenger’s syndrome 3183 4.2.1 Pulmonary hypertension 3183 4.2.2 Eisenmenger’s syndrome 3183 4.2.3 Cyanotic heart disease without pulmonary hypertension 3184 4.3 Specific congenital heart defects 3184 4.3.1 Left ventricular outflow tract obstruction 3184 4.3.2 Atrial septal defect 3184 4.3.3 Ventricular septal defect 3184 (...) of this classification, and follow-up and management during pregnancy according to this mWHO classification, are presented in Table . Indications for intervention (surgical or catheter) do not differ in women who contemplate pregnancy compared with other patients. The few exceptions to this rule are women with at least moderate mitral stenosis and women with aortic dilatation. See also the disease-specific sections of these Guidelines. Fertility treatment is contraindicated in women with mWHO class IV, and should

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2018 European Society of Cardiology

12. The 2012 Canadian Hypertension Education Program recommendations for the management of hypertension: Blood pressure measurement, diagnosis, assessment of risk, and therapy

pharmacological therapy to control hypertension? (6) What BP level should be attained in hypertensive patients and in patients with coexisting diabetes or CKD? (7) What lifestyle interventions are effective in preventing hypertension and reducing BP? (8) What are the optimal pharmacological agents for treatment of hypertension, as well as hypertension occurring in patients with specific comorbid conditions, including diabetes, cardiovascular disease, stroke, or kidney disease? (9) How can we improve adherence (...) of the evidence, BP targets for patients with nondiabetic chronic kidney disease (CKD) is now < 140/90 mm Hg instead of < 130/80 mm Hg; (4) The BP target for patients with hypertension and diabetes mellitus did not change ( < 130/80 mm Hg) based on evaluation of recent meta-analyses. Recommendations on lifestyle modifications to prevent and treat hypertension, indications for pharmacologic management of hypertension, treatment thresholds and targets, choice of therapy for adults with hypertension and without

2012 CPG Infobase

13. Management of Valvular Heart Disease

. Table 3 Essential questions in the evaluation of patients for valvular intervention VHD = valvular heart disease. a Life expectancy should be estimated according to age, sex, comorbidities, and country-specific life expectancy. 3.1 Patient evaluation Precise evaluation of the patient’s history and symptomatic status as well as proper physical examination, in particular auscultation and search for heart failure signs, are crucial for the diagnosis and management of VHD. In addition, assessment (...) is a key component in decision making. The essential questions in the evaluation of a patient for valvular intervention are summarized in Table . The current background information and detailed discussion of the data for the following section of these Guidelines can be found in . Table 3 Essential questions in the evaluation of patients for valvular intervention VHD = valvular heart disease. a Life expectancy should be estimated according to age, sex, comorbidities, and country-specific life expectancy

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2017 European Society of Cardiology

14. Non-alcoholic Fatty Liver Disease, Diagnosis and Management

- characterizedNAFLDsubjectsfromtheNASHClinical Research Network (NASH CRN), signi?cant elevations in serum autoantibodies (antinuclear antibodies>1:160 or antismooth muscle antibodies>1:40) were present in 21% andwerenotassociatedwithmoreadvanceddisease oratypicalhistologicalfeatures. (87) CHALASANI ET AL. HEPATOLOGY, January 2018 334While other diseases are being excluded, history shouldbecarefullytakenforthepresenceofcommonly associated comorbidities, including central obesity, hypertension, dyslipidemia, diabetes or insulin resis- tance (...) Non-alcoholic Fatty Liver Disease, Diagnosis and Management The Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance From the American Association for the Study of Liver Diseases Naga Chalasani, 1 Zobair Younossi , 2 Joel E. Lavine, 3 Michael Charlton, 4 Kenneth Cusi, 5 Mary Rinella, 6 Stephen A. Harrison, 7 Elizabeth M. Brunt, 8 and Arun J. Sanyal 9 Preamble This guidance providesadata-supportedapproachto the diagnostic, therapeutic, and preventive aspects

2018 American Association for the Study of Liver Diseases

15. Hypertension - Diagnosis and Management

management is recommended for those with mild hypertension (average blood pressure = 140 – 159/90 – 99), low-risk for cardiovascular disease and no co-morbidities. [Level 1, 2008] Definition An elevated blood pressure (BP) is defined as a systolic blood pressure (SBP) > 140 mm Hg or diastolic blood pressure (DBP) > 90 mm Hg or both. Detection In patients aged ≥ 45 years, BP should be recorded at least once every 5 years. This recording should be the average of several measurements. Ensure standardized (...) is ≥ 160/100; or Desirable BP is not reached with lifestyle management. Treatment of Hypertension without Specific Indications In general, antihypertensive medications are equally effective in lowering BP. When prescribing one, take into account cost of the drug, any side-effects and any potential contraindications. For a list of commonly prescribed antihypertensive medications in each class, refer to Without specific indications, consider monotherapy with one of the following first-line drugs

2015 Clinical Practice Guidelines and Protocols in British Columbia

16. Hypertension in adults: diagnosis and management

disease Hypertension in adults: diagnosis and management (CG127) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 7 of 25renal disease diabetes a 10-year cardiovascular risk equivalent to 20% or greater. [2011] [2011] Offer antihypertensive drug treatment to people of any age with stage 2 hypertension. [2011] [2011] For people aged under 40 years with stage 1 hypertension and no evidence of target organ damage (...) of hypertension. [2004, amended [2004, amended 2011] 2011] 1.3 Assessing cardiovascular risk and target organ damage For NICE guidance on the early identification and management of chronic kidney disease see 'Chronic kidney disease' (NICE clinical guideline 73, 2008). 1.3.1 Use a formal estimation of cardiovascular risk to discuss prognosis and healthcare options with people with hypertension, both for raised blood pressure and other modifiable risk factors. [2004] [2004] 1.3.2 Estimate cardiovascular risk

2011 National Institute for Health and Clinical Excellence - Clinical Guidelines

17. Hypertensive Urgency: Considerations for Management

crystal meth or ecstasy), anabolic steroids, caffeine, cocaine, phencyclidine. Energy drinks containing taurine, guarana root, yerba mate, glucuronolactone, etc. o Lifestyle 1 - High salt diet, excessive alcohol use. o Comorbid Conditions 2 - Thyroid storm, trauma, renovascular disease, acute ischemic stroke or adrenal dysfunction ? Some population groups are more likely to experience hypertensive urgency 10 : Elderly; African Americans; Men > Women HOW SHOULD HYPERTENSIVE URGENCY BE MANAGED? 1-11 (...) Hypertensive Urgency: Considerations for Management RxFiles Q&A Summary www.RxFiles.ca - updated June 2016 K Krahn UofS BSP Student 2014 , L Regier BSP, BA HYPERTENSIVE URGENCY (ASYMPTOMATIC SEVERE HYPERTENSION) : CONSIDERATIONS FOR MANAGEMENT Hypertension is one of the most common chronic medical conditions in Canada. More than one in five Canadians has hypertension and the lifetime risk of developing hypertension is 90%. 1 With the addition of comorbid conditions and other risk factors

2014 RxFiles

18. Hypertension Management for Specific Comorbid Diseases

Hypertension Management for Specific Comorbid Diseases Hypertension Management for Specific Comorbid Diseases Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse (...) Cancer Administration 4 Hypertension Management for Specific Comorbid Diseases Hypertension Management for Specific Comorbid Diseases Aka: Hypertension Management for Specific Comorbid Diseases , AntiHypertensives for Specific Comorbid Diseases From Related Chapters II. Management: Endocrine Conditions (with or without ) See or In black patients, use or instead s III. Management: Cardiovascular Conditions (Risk of sudden death) Central active agonists s s or (use with caution, CIBIS II, MERIT-HF

2015 FP Notebook

19. Comorbid Conditions in Idiopathic Pulmonary Fibrosis: Recognition and Management (PubMed)

assessment is the recognition and appropriate management of comorbid conditions. Though IPF is characterized by single organ involvement, many comorbid conditions occur within other organ systems. Common cardiovascular processes include coronary artery disease and pulmonary hypertension (PH), while gastroesophageal reflux and hiatal hernia are the most commonly encountered gastrointestinal disorders. Hematologic abnormalities appear to place patients with IPF at increased risk of venous thromboembolism (...) Comorbid Conditions in Idiopathic Pulmonary Fibrosis: Recognition and Management Idiopathic pulmonary fibrosis (IPF), a fibrosing interstitial pneumonia of unknown etiology, primarily affects older adults and leads to a progressive decline in lung function and quality of life. With a median survival of 3-5 years, IPF is the most common and deadly of the idiopathic interstitial pneumonias. Despite the poor survivorship, there exists substantial variation in disease progression, making accurate

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2017 Frontiers in medicine

20. AHA/ACC/HHS Strategies to Enhance Application of Clinical Practice Guidelines in Patients With Cardiovascular Disease and Comorbid Conditions

% have ≥6 chronic conditions. , Comorbidities and Cpgs for Cardiovascular Conditions CPGs jointly developed by the AHA/ACC are cardiovascular disease-specific documents focused on the prevention, diagnosis, and management of conditions such as ischemic heart disease, heart failure, and atrial fibrillation. These CPGs often contain considerations for special factors (eg, older adults) and common problems affecting pharmacokinetics (eg, renal impairment). For example, the 2014 CPG on atrial (...) is the exception rather than the rule. Second, whereas common risk factors such as hypertension and hyperlipidemia are associated with the index cardiovascular conditions, the index conditions are associated with a constellation of comorbidities, the pathophysiology of which may be distinct from the index condition and for which prevalence increases with age or other factors. Organizations that develop CPGs must now consider comorbidities during the development process for disease-specific CPGs. For high

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2014 American Heart Association

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