Hypertension - GENERAL CME OVERVIEW

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STATEMENT OF NEED: Hypertension (HTN) remains a major contributor to disease burden around the world and a major cause of premature death. Nearly 1 in 5 Americans suffer from hypertension, making it the nation’s #1 most common medical condition [1]. At specific risk are women, persons aged 60 or older, non-Hispanic blacks, the poor, and diabetics [2]. The progression from hypertension to heart failure in the chain of cardiovascular events, however, need not be inevitable and can be prevented with proper treatment. Since only approximately 58% of patients diagnosed with hypertension are receiving adequate treatment [1], primary care physicians are well positioned to improve diagnosis and treatment strategies and potentially improve patient outcomes. However, a 2009 needs assessment of primary care physicians conducted by PennCME/BestPractice revealed the following gaps in disease management:

  • Gaps in diagnosis exist, which are partially attributed to a lack of awareness of hypertension among patients [3].
  • Barriers to control of hypertension are a function of several factors, including patient management time constraints, physician practice patterns, patient/physician communication challenges, adverse drug effects, and the complexity of prescribing or monitoring drug regimens [4, 5, 6].
  • Physicians need to improve their adherence to treatment guidelines, and more aggressively manage their patients’ disease [7, 8, 9, 10].

TARGET AUDIENCE: Physicians in primary care practice, physician assistants, nurse practitioners, and other health care providers and clinical practice teams.

EDUCATIONAL GOALS & OBJECTIVES: After participating in this educational initiative, learners are generally expected to:

  • Improve the performance of primary care providers in screening patients for hypertension and pre-hypertension.
  • Improve competence and performance of primary care providers in diagnosing hypertension and pre-hypertension.
  • Improve knowledge, competence, and performance of primary care providers in treatment of hypertension and patient management according to guidelines.
  • Educate and motivate primary care providers to engage their patients in self management of their disease by providing tools and resources for best practices in smoking cessation and other lifestyle changes.

Media Use: This educational initiative was developed as a web-based multimedia self-study educational and resource curriculum using the following formats:

  • Interactive minicase studies
  • Internet-based enduring materials
  • Evidence-based resources
  • References to physician staff and patient education links

FORMATS & METHOD OF LEARNER PARTICIPATION IN THE PennCME/BestPractice HTN CURRICULUM LEARNING PROCESS:

FACULTY, AUTHORS, & CONTRIBUTORS:

Zalman S. Agus, MD, Editor-in-Chief
Associate Dean for CME
Emeritus Professor of Medicine
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania

Dr Agus is Executive Editor and Associate Dean for Continuing Medical Education and Emeritus Professor of Medicine at the Perelman School of Medicine at the University of Pennsylvania, and a recognized leader in medical education, medical journalism, and electronic media-based technologies in physician learning. Dr. Agus was previously Chief of the Renal and Electrolyte Section and Director of the Fellowship Training Program. He has published over 120 articles and textbook chapters and served as Coordinating Editor of UptoDate in Medicine. He was elected a member of the American Society for Clinical Investigation and is a Fellow of the American College of Physicians.

Norman Kaplan, MD, Faculty
Clinical Professor of Medicine
University of Texas Southwestern Medical Center
Dallas, TX

Dr Kaplan received his medical degree from the University of Texas Southwestern Medical Center. Subsequently, he completed residency in internal medicine at Parkland Memorial Hospital in Dallas. Dr Kaplan's research focuses primarily upon clinical aspects of hypertension. He received the Lifetime Achievement Award by the American Heart Association’s Council for High Blood Pressure Research, and received the Stevo Julius Award for Leadership in Medical Communication presented by the International Society of Hypertension. He has lectured extensively and published over 500 articles. The eighth edition of his textbook, Kaplan's Clinical Hypertension, was published in early 2002.

Suzanne Oparil, MD, Faculty
Professor of Medicine, Physiology and Biophysics
Director, Vascular Biology & Hypertension Program
Division of Cardiovascular Disease
Department of Medicine
University of Alabama at Birmingham
Birmingham, Alabama, USA

Dr Oparil received her medical degree from Columbia University College of Physicians and Surgeons, and completed a fellowship at the Massachusetts General Hospital in Boston. She is a past-President of the American Heart Association, and was the first woman past-President of the American Federation for Medical Research. Dr Oparil has a career interest in the fundamental mechanisms of cardiovascular disease and in using the information to develop novel treatments. She has made many seminal contributions to hypertension research, including the first description of angiotensin-converting enzyme (ACE) activity in the lung, definition of the role of the central nervous system in salt sensitivity of blood pressure, and assessment of the contribution of the intracardiac renin-angiotensin system in the pathogenesis of cardiac hypertrophy. Dr Oparil is author and coauthor of more than 1,000 abstracts, book chapters, and journal articles in Circulation, New England Journal of Medicine, and American Journal of Hypertension, among others.

Medical Editor
Lewis Miller, MS, CCMEP
Principal, WentzMiller & Associates
Darien, Connecticut 

Medical Writers
Anne Greenberg, Medical Writer
Scottsdale, Arizona

Rick McGuire, Medical Writer
Scottsdale, Arizona

Program Directors
Chief Learning Officer

Mila Kostic, CME Director and Chief Learning Officer
Director of CME
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania

Chief Technology Officer
Lauren Patrick MS
President, NetHealth
Malvern, Pennsylvania

Editorial Director
Wendy Turell, DrPH, Editorial Director

Editorial Board
Joseph E. Scherger, MD, MPH, Editorial Board
Professor of Clinical Family and Preventive Medicine
Director, San Diego Center for Patient Safety
Medical Director, Quality Improvement Education
Director, Quality Improvement in Correctional Medicine
University of California, San Diego School of Medicine (UCSD)
San Diego, California

Matthew H. Rusk, MD, Editorial Board
Associate Professor of Clinical Medicine
Program Director, Primary Care Program
Staff Internist, Division of General Medicine
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania

Dennis F. Saver, MD,  Editorial Board
President and Staff Physician, Primary Care of the Treasure Coast
Clinical Assistant Professor of Family Medicine
Florida State University
Vero Beach, Florida

Peter J. Ziemkowski, MD,  Editorial Board
Assistant Professor, Department of Family Medicine
College of Human Medicine
Michigan State University
Clerkship Director and Physician/Faculty
Michigan State University–Kalamazoo Center for Medical Studies
Kalamazoo, Michigan

Patricia M. Bomalaski, MSN, CRNP, Editorial Board
Department of Medicine
Penn Center for Primary Care
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania

Jesse A. Coale, PA-C, Editorial Board
Assistant Professor Philadelphia University
Philadelphia, Pennsylvania

Michael A. Rackover, PA-C, MS, Editorial Board
Associate Program Director & Associate Professor Physician Assistant Program Philadelphia University
Philadelphia, Pennsylvania

Instructions for Obtaining CME Credit

To obtain Credit Certificate for CME-certified activities follow these steps:

  • Review the topic- and activity-specific overview
  • Complete the brief case-based pre-activity assessment
  • Review the entire educational activity
  • Answer all case-based questions in the post-activity assessment
  • Complete the evaluation
  • Proceed to view or print your certificate stored in your Personal Learning Center

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

Designation of Credit
These activities have been approved for AMA PRA Category 1 Credit(s)™.

Disclosure of Commercial Support
Supported, in part, by educational grants from Abbott Laboratories,  Daiichi Sankyo, Inc., Genentech, Inc., GlaxoSmithKline, Lilly USA LLC, and Takeda Pharmaceuticals North America, Inc.

Disclosures of Personal Financial Relationships
It is policy at the Perelman School of Medicine at the University of Pennsylvania for individuals who are in a position to control the content of an educational activity to disclose to the learners all relevant financial relationships that they have with any commercial interest that provides products or services that may be relevant to the content of these continuing medical education activities. For this purpose, we consider relationships of the person involved in the CME activity to include financial relationships of a spouse or partner.

The intent of this policy is not to prevent expert faculty with relevant relationship(s) with commercial interest(s) from involvement in CME, but rather to ensure that Penn CME-certified activities promote quality and safety, are effective in improving medical practice, are based on valid content, and are independent of control from commercial interests and free of commercial bias. Peer review of all content was conducted for all faculty presentations whose disclosure information provided to the Penn Office of CME was found to contain relationships that created a conflict of interest relative to the topic of their presentation. In addition, all faculty were instructed to provide balanced, scientifically rigorous, and evidence-based presentations.

The staff in the Office of CME at the Perelman School of Medicine at the University of Pennsylvania, Mila Kostic, and Zalman Agus, MD, have reported no relevant financial relationships with any commercial interests related to the content of these educational activities.

The following staff member and medical writers have reported no relevant financial relationships with any commercial interests related to the content of these educational activities:  
       Wendy Turell, DrPH
       Anne Greenberg
       Rick McGuire

The following staff members have reported the listed relevant financial relationships with commercial interests related to the content of these educational activities:
       Lewis A. Miller, MS, is a consultant for Takeda Pharmaceuticals North America, Inc.

The following editorial board members have disclosed that they have no relevant financial relationships with any commercial interests related to the content of these educational activities:  
      Patricia M. Bomalaski, MSN, CRNP
      Matthew Rusk, MD
      Joseph E. Scherger, MD, MPH
      Peter Ziemkowski, MD
      Jesse A. Coale, PA-C

The following editorial board members have reported the listed relevant financial relationships with commercial interests related to the content of these educational activities. 

Faculty Name

Name of Commercial Interest

Relationship

Michael A. Rackover, PA- C, MS GSK Spouse is an employee
Dennis Saver, MD Boehringer Ingelheim
Genzyme
First Consult
Consultant

Board Member

The following faculty have disclosed that they have no relevant financial relationships with any commercial interests related to the content of these educational activities:
      Norman M. Kaplan, MD

The following faculty have reported the listed relevant financial relationships with commercial interests related to the content of these educational activities:

Faculty Name Name of Commercial Interest Relationship
Suzanne Oparil, MD Boehringer-Ingelheim Consultant
  Daiichi Sankyo Inc. Grants/Research Support, Consultant and Speaker
  Eli Lily Consultant
  Forest Consultant
  Gilead   Grants/Research Support
  Merck Speaker and Consultant
  NicOx Consultant
  Novartis Consultant and Speaker
  The Salt Institute Consultant
  Takeda Grants/Research Support
  VIVUS Consultant

Relevant Financial Relationships:
Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received or expected.

INVESTIGATIONAL AND/OR OFF-LABEL USE OF COMMERCIAL PRODUCTS AND DEVICES: The Perelman School of Medicine at the University of Pennsylvania requires all faculty to disclose any planned discussion of an investigational and/or off-label use of a pharmaceutical product or device within their presentation. Participants should note that the use of products outside FDA-approved labeling should be considered experimental and are advised to consult current prescribing information for approved indications.

The faculty reported that there will be no specific mentions of off-label and/or investigational use of products within their presentations.

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For CME-related questions, please contact the Office of CME at the Perelman School of Medicine at the University of Pennsylvania at penncmebpcpd@penncme.com

CME ACTIVITY OVERVIEW

Given the importance blood pressure plays in maintaining one’s health, proper technique should be emphasized when taking a reading of blood pressure levels. In this activity, correct practice in terms of timing, positioning, equipment, and more will be outlined to improve accurate blood pressure measurements in patients.

Learning Objectives: Upon completion of this educational activity, the participant should be able to: 

  • Avoid common errors made in executing blood pressure readings
  • Instruct patients/staff on proper measurement of blood pressure readings

Author: Norman Kaplan, MD
Medical Writers: Anne Greenberg, Rick McGuire
Editor-in-Chief: Zalman S. Agus, MD

Original Date of Release: February 2, 2011
Last Review Date: July 1, 2011
Expiration Date: July 1, 2014

Estimated Time to Complete: 30 minutes

Amount of credit: Maximum of 0.5 AMA PRA Category 1 Credits

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

Designation of Credit: The Perelman School of Medicine at the University of Pennsylvania designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Supported, in part, by educational grants from Abbott Laboratories,  Daiichi Sankyo, Inc., Genentech, Inc., GlaxoSmithKline, Lilly USA LLC, and Takeda Pharmaceuticals North America, Inc.

Copyright © 2010-2013  Perelman School of Medicine at the University of Pennsylvania Office of Continuing Medical Education. All rights reserved.