Continuing Medical Education (CME)

Hypertension: Essential Hypertension in Adults

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
(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:

• BP classification has been changed.  Prehypertension defines BP of 120-139/80-89; lifestyle modification would benefit those in this category.  BP>160/100 is now single category: Stage 2.
• Screening for diabetes is recommended.
• Beta blockers, particularly atenolol, are not preferred as initial treatment in the elderly.
• Peripheral alpha blockers should not be used as initial therapy.

Key aspects of care are:

• Diagnosis is best using mean BP levels over several visits, and careful calibration of the BP monitor.
• Target BP therapy is 140/90 mm Hg or less for patients without diabetes or renal insufficiency and is 135/80 mm Hg or less for patients with diabetes, renal disease, cardiovascular disease or cerebrovascular disease.
• Thiazide diuretics are generally the preferred initial drug treatment.
• Add second and third agents as needed.  ACE inhibitors, angiotensin receptor blockers, and long-acting dihydropyridine calcium channel blockers are the first choice additional agents.
• Patient education and self-management is fundamental to successful therapy.

Audience

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

Authors

Team Leader
	Masahito Jimbo, MD Family Medicine
Team Members
	William Barrie, MD General Medicine Michael P Dorsch, PharmD Pharmacy R Van Harrison, PhD Medical Education Kenneth Jamerson, MD Cardiovascular Medicine
Author Disclosures
	Team Member Company Relationship William Barrie, MD None   Michael P. Dorsch, PharmD Briston-Myers Squibb, Sanofi-Avantis Speakers Bureau R Van Harrison, PhD None   Kenneth Jamerson, MD Novartis, King Abbott, Bristol-Myers Squibb, GlaxoSmithKline, King, Merck, Sankyo, Sanofi-Aventis Grant Consultant   Bristol-Myers Squibb, Merck, Novartis Speakers Bureau Masahito Jimbo, MD None

Other Acknowledgements

UMHS Guidelines Oversight Team: William E. Chavey, MD R. Van Harrison, PhD Connie J. Standiford, MD Literature search services: Taubman Medical Library Production of Internet format and web site 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 educational activity for a maximum of 1 AMA/PRA Category 1 Credits™.  Physicians should only claim credit commensurate with the extent of their participation in the activity.

This CME activity was prepared for release in February 2009 with credit available through February 2012. The activity was reviewed for currency of content in February 2012 and availability of credit extended through February 2015.  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.

 

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