Hypertension - GENERAL CME OVERVIEW
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 . At specific risk are women, persons aged 60 or older, non-Hispanic blacks, the poor, and diabetics . 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 , 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 .
- 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:
- Clinical reviews in HTN present critical areas of knowledge in the disease organized in a coherent pathway, along with practical approaches to achieving best practices. This section provides a foundation and reference base for other featured interventions.
- Hot Topics are short, newsworthy articles in a focused area of the diagnosis or management of HTN. These articles are designed to engage the participant in the topic area and lead them to content that provides the opportunity for more in-depth learning.
- Improving blood pressure: How valuable is a team approach?
- What is prehypertension and what can you do about it?
- Five common errors in measuring blood pressure
- Hypertension in women
- Hypertension in patients with cardiovascular disease
- Hypertension in patients with CHF
- When to treat hypertension in the very elderly
- Hypertension in blacks
- Hypertension in children and adolescents
- Hypertension in type 2 diabetes and in chronic kidney disease
- Interactive Minicases offer a valuable learning experience based on real-life scenarios of interactions between primary care physicians, the health practice team, and patients with HTN. This method of engagement allows participants to build their knowledge and competence as they engage and progress through case simulation of both the clinical management of patients with HTN and some system-specific issues in their practices.
- Clinical Resources and References provide a bibliography of cited evidence-based references and links to resources featured in this section.
- Building Teamwork provides clinicians and non-clinical staff with resources, educational activities, and tools for promoting teamwork in their practice and collaborative strategies to achieve performance improvement.
- Staff Resources Whether you’re a PA, NP, medical assistant, or staff receptionist, this site can help improve your knowledge and management of patients with chronic diseases.
- Patient Resources provide patients with practical information and tools about their health and medical conditions to promote patient self-management and patient-physician partnerships.
- Patient Centered Medical Home offers a stimulating set of concepts for bringing your practice into the 21st century – including updates on electronic health records and other government-supported programs.
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
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
Lewis Miller, MS, CCMEP
Principal, WentzMiller & Associates
Chief Learning Officer
Mila Kostic, CME Director and Chief Learning Officer
Director of CME
Perelman School of Medicine at the University of Pennsylvania
Chief Technology Officer
Lauren Patrick MS
Wendy Turell, DrPH, Editorial Director
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
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
Patricia M. Bomalaski, MSN, CRNP, Editorial Board
Department of Medicine
Penn Center for Primary Care
Hospital of the University of Pennsylvania
Jesse A. Coale, PA-C, Editorial Board
Assistant Professor Philadelphia University
Michael A. Rackover, PA-C, MS, Editorial Board
Associate Program Director & Associate Professor Physician Assistant Program Philadelphia University
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
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
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.
Name of Commercial Interest
|Michael A. Rackover, PA- C, MS||GSK||Spouse is an employee|
|Dennis Saver, MD||Boehringer Ingelheim
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|
|Merck||Speaker and Consultant|
|Novartis||Consultant and Speaker|
|The Salt Institute||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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CME ACTIVITY OVERVIEW
Certain differences exist between the age-specific prevalence of hypertension and gender-based disparities in management of the disease. This topic discusses these issues, as well as hypertension associated with oral contraceptives and hypertension in pregnancy.
Learning Objective: Upon completion of this educational activity, the participant should be able to treat hypertension appropriately in female populations, including pregnant women.
Original Date of Release: December 23, 2010
Last Review Date: December 23, 2010
Expiration Date: June 30, 2013
Estimated Time to Complete: 15 minutes
Amount of credit: Maximum of 0.25 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 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.