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hypertension

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AAFP Affirms Value of New Cholesterol Management Guideline

The AAFP recently gave its "affirmation of value" designation to a cholesterol management guideline jointly developed by the American College of Cardiology and the American Heart Association.

https://www.aafp.org/news/health-of-the-public/20190320acc-ahacholguidln.html

AAFP and ACP Publish Recommendations on Diagnosis and Management of VTE - Practice ...

Oct 15, 2007 - Recommendations on diagnosis and management of venous throm-boembolism (VTE) have been published by the American Academy of Family Physicians (AAFP) and the American College of Physicians (ACP).

American Family Physician : Practice Guidelines

https://www.aafp.org/afp/2007/1015/p1225.html

AAFP Backs Breastfeeding, Lactation for Medical Trainees

The AAFP has updated its policy supporting breastfeeding and lactation accommodations for medical trainees, which other medical organizations plan to use as model policy for their members.

https://www.aafp.org/news/health-of-the-public/20190626breastfeedpolicy.html

AAFP Delivers Useful Clinical Resources for 2018

The AAFP offered a wide range of clinical recommendations and resources throughout 2017 -- including practice guidelines, immunization guidance and preventive services recommendations -- that members can use in 2018 and beyond.

https://www.aafp.org/news/resources-tools-2018/20180103yir-clinical.html

AAFP FMX 2020

...Hypertension: The Pressure's On! David M Schneider, MD Family Physician Santa Rosa Family Medicine Residency Clinical Professor of Family and Community Medicine, UCSF ACTIVITY DISCLAIMER The material presented here is being made available by the American Academy of Family...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-012.pdf

AAFP FMX 2020

...Hypertension Treatment of Resistant Hypertension Chuck Carter, MD, FAAFP Clinical Professor University of South Carolina School of Medicine ACTIVITY DISCLAIMER The material presented here is being made available by the American Academy of Family Physicians for educational...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-016.pdf

AAFP FMX 2020

...2. Explain the 2013 changes from the American College of Obstetricians and Gynecologists (ACOG) Hypertension Disorder Guidelines with emphasis on diagnosis of preeclampsia with severe features. 3. Formulate a prevention and management strategy to include determination for the...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-155.pdf

AAFP FMX 2020

...• PMH - Type 2 DM; last AIC 7.2% - HTN • Medications: - Metformin 500 mg bid - Lisinopril/HCTZ 20/12.5 mg daily - Simvastatin 40 mg daily - ASA 81 mg daily • Exam: - BP 132/78, P 84, BMI 31 - Heart: irregularly irregular S1, S2 without murmur - Lungs clear; extremities without...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-005.pdf

AAFP FMX 2020

...leading to inability to cooperate • Mod stenotic valvular heart dz • Recent stroke or TIA • Severe HTN (SBP ≥200 and/or DBP ≥110) • Tachy- or bradyarrhythmias, incl AFib w/RVR Absolute Contraindications Relative Contraindications Circulation 2002;106:1883-92; Am Fam...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-006.pdf

AAFP FMX 2020

...• 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline moved HTN from >/= 140/90 to >/= 130/80 mm Hg • Isolated Diastolic Hypertension (IDH) as >/= 80 mm Hg (expert opinion) • 18,000+ Tx of IDH over 25 years: • Tx > 80 mmHg did NOT Decrease •...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-103.pdf

AAFP FMX 2020

...• Diabetes • ASCVD • Hyperlipidemia • Hypertension Time for just one thing? • For children < 6, parental obesity is strongest predictor of childhood obesity. 27 28 9/15/2020 15 Screen for Food Insecurity (FI) Screen with Hunger Vital Sign: For each of the...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-093.pdf

AAFP FMX 2020

...• Hypertension (>140/90 mmHg or on therapy for hypertension) • History of CVD Diagnosis Borderline diabetes 29 30 Diagnosis Borderline diabetes 2020 ADA: Prediabetes Diagnosis Impaired glucose tolerance: 2 hr glucose in 75g OGTT 140-199 mg/dL OR Impaired...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-038.pdf

AAFP FMX 2020

...cardiopulmonary disease −Hypertrophic cardiomyopathy (HCM), dilated/restrictive cardiomyopathies −Valvular heart disease −Pulmonary HTN Syncope: Diagnostic Evaluation •History •Physical Exam •Labs only as indicated from the hx and PE •Every patient should receive an EKG...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-014.pdf

AAFP FMX 2020

...A. Turner Syndrome B. Essential hypertension C. Trauma D. Diabetes mellitus E. Ehlers-Danlos syndrome Question 1 Which of the following is NOT a risk factor for thoracic aneurysm dissection? A. Turner Syndrome B. Essential hypertension C. Trauma D. Diabetes mellitus E....

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-036.pdf

AAFP FMX 2020

...A. 35-year-old with severe hypertension B. 60-year-old with new-onset renal failure C. 60-year-old with hypertension and a 20-pack-year smoking history D. 68-year-old with a 5-pack-year smoking history E. Insufficient evidence to recommend for women age 65-75 who have ever smoked...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-162.pdf

AAFP FMX 2020

...• Hypertension • Diabetes • Smoking • High cholesterol • Overweight and obesity • Physical inactivity • Depression 7 8 AES Question AES Question 1 Which of the following risk factors have a greater adverse effect in women than in men? A. Hypertension B. Diabetes C....

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-007.pdf

AAFP FMX 2020

...Ascites/decompensated liver failure Right HF from other causes (RV infart, idiopathic pulmonary HTN, arrhythmogenic RV) Chronic kidney disease High-output heart failure 15 16 HFpEF Evaluation • Labs: CBC, CMP, TSH, UA • ECG: CAD, LVH, dysrhythmia - 50% have atrial...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-010.pdf

AAFP FMX 2020

...Patient Presentation HPI: A 56-year-old male with a medical history significant for HTN, HLD, GERD, hypothyroidism, and post-9/11 syndrome of COPD was brought to the clinic by his wife, after she noticed he was developing deficits in his field of vision in addition to...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-100.pdf

AAFP FMX 2020

...Mrs D recently retired but is active volunteering and watching her grandchildren. She was diagnosed with hypertension four years ago and is well controlled with lisinopril 20mg daily. She is moderately overweight with a BMI of 28. She was recently found to have an elevated A1c of...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-055.pdf

AAFP FMX 2020

...takes a budesonide/formoterol inhaler daily for asthma, which is typically well controlled with an ACT score of 22. He also takes an ACEi for HTN. He denies recent travel or known exposure to a COVID positive patient. He is febrile at 102F and has a pulse oximetry reading of 96%....

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-099.pdf

AAFP FMX 2020

...into your office… • 78-year-old female • Hypertension, Chronic Kidney Disease, Atrial Fibrillation on Coumadin, Rheumatoid Arthritis • No recent hospitalizations • 12 medications • No alcohol or smoking • 80-year-old male • Hypertension, Diabetes, COPD, Heart Failure...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-115.pdf

AAFP FMX 2020

...History of Hypertension •ASA daily from 13 weeks •Chronic hypertension-treat if > 150 systolic and/or >105 diastolic •Previous pre-eclampsia-screen, observe closely •Consider checking kidney function ACOG Practice Bulletin #203 Chronic Hypertension in Pregnancy 12/18 AES...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-157.pdf

AAFP FMX 2020

...•Patient with severe COPD, still smoking −Possible pulmonary HTN, listen for: • Fixed split S2, right sided murmurs that change with respiration •Patient with HFrEF and an EF = 15% −Likely to have mitral regurgitation murmur AES Question 33 34 9/10/2020 18...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-017.pdf

AAFP FMX 2020

...male you diagnosed with HTN and HLD and were considering prescribing a statin, so you checked hepatic function panel. ALT and AST are 2x ULN. Rest of hepatic function panel is negative. Patient denies symptoms of liver disease. He takes amlodipine for HTN. He denies alcohol use. His...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-046.pdf

AAFP FMX 2020

...College of Radiology; CT=computed tomography; MRI=magnetic resonance imaging; SAH=subarachnoid hemorrhage; IIH=idiopathic intracranial hypertension. Douglas AC et al. J Am Coll Radiol. 2014;11:657‐667. Clinical Features/Red Flags Suspected Condition Recommended Imaging*...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-078.pdf

AAFP FMX 2020

...• Hypertension - Initiation of BP therapy is indicated for previously untreated patients with ischemic stroke or TIA who, after the first several days, have an established BP ≥140 mmHg systolic or ≥90 mmHg diastolic (Class I; Level of Evidence B). - Initiation of therapy for...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-080.pdf

AAFP FMX 2020

...Mr. Smith is 62, and has DM2, HTN, and HLD. His most recent A1C was 9.3. What level of risk would you assign for this patient? A. Level 4 B. Level 5 C. Level 6 D. Need more information Mr. Smith is 62, and has DM2, HTN, and HLD. His most recent A1C was 9.3. What level of...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-111.pdf

AAFP FMX 2020

...Complex Chronic Care •HTN •HLD •CAD •CVA •PVD •Addiction •Hospital Discharge Continuity • HTN • DM • HLD • $50-$150/Visit • No matter how sick Well Care • CRC • BC • Flu Shot Condition Specific Care • diabetes • CHF Adapted from: Reframing Healthcare: A Roadmap For...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-117.pdf

AAFP FMX 2020

...given birth to an infant weighing 4,000g (approximately 9 lb) or more • Previous gestational diabetes mellitus • Hypertension (140/90 mm Hg or on therapy for hypertension) • Women with polycystic ovarian syndrome • Prediabetes 31 32 9/14/2020 17 USPSTF recommendations...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-142.pdf

AAFP FMX 2020

...Hypertension - Maternal obesity independent risk factor for development of a hypertensive disorder of pregnancy - Risk PEC doubles with every 5-7 kg/m2 increase in pre-pregnancy BMI - Women undergoing pre-pregnancy bariatric surgery significantly decreases risk development...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-148.pdf

AAFP FMX 2020

...•Caused by venous hypertension from residual venous obstruction by thrombus •Develops in 20%-50% following a DVT despite anticoagulant treatment •Severe PTS in 5%-10% of cases •Most cases occur within 1 year of acute DVT •Symptoms similar to those of primary venous...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-013.pdf

AAFP FMX 2020

...is a 73 y.o. retired school teacher who comes in with productive cough for 2 days, some chills, and fatigue. No fever. She has Type 2 DM and HTN both controlled with medication. She has stage IV CKD with her last GFR = 25. No hemoptysis, vomiting, diarrhea, or chest pain. No flu...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-048.pdf

AAFP FMX 2020

...•Associated Conditions −Hypertension −Dyslipidemia −Small for Gestational Age Birth Weight Standards of Medical Care in Diabetes-2014 American Diabetes Association Diabetes Care 2014 Jan; 37(Supplement 1): S14-S80 When and How? •Start at age 10 or onset of puberty if before...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-097.pdf

AAFP FMX 2020

...Patient Characteristics: Age, DM, HTN, birth weight, prenatal care, Obstetrical history, multiple gestation, abruption, previa, accreta, anticoagulant use during pregnancy, (Grobman 2015) A cohort study of 115,502 women who delivered at 25 hospitals across the United States over...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-106.pdf

AAFP FMX 2020

...Hypertension Hypertension Released Coronary Heart Disease Heart DiseaseHeart Failure Diabetes Diabetes November/December 2020 Preventive Medicine Preventive HealthHealth Behaviors Asthma Asthma Depression Mental Health CareMental Health Vulnerable Elderly Care of Older...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-110.pdf

AAFP FMX 2020

...• height/weight, body mass index (BMI) • hypertension (systolic/diastolic blood pressure) • blood lipids (HDL/LDL and total cholesterol, triglycerides) • blood glucose (blood sugar and hemoglobin A1c levels) - Psychosocial risks • depression/life satisfaction • stress/anger •...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-122.pdf

AAFP FMX 2020

...A. Obesity B. Hypertension C. Sexual dysfunction D. Infertility E. A, C and D AES Question 1 19 yo, healthy, no meds CC: irregular menstrual cycles Menarche age 12, somewhat irregular over the years For the past year, menses q 4-5 months LMP 6 months ago What other symptom(s)...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-152.pdf

AAFP FMX 2020

...cesarean (CS) rates (Induction of labor rates increasing) • Higher rates of unintended pregnancies, drug and alcohol use, grand multiparity, HTN in pregnancy • Medicaid is the single largest payor for maternity care (43% of all US births or 1.7 of 3.9 million births/year) covers...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-158.pdf

AAFP FMX 2020

...•72 yo Black male: −Has osteoarthritis of both knees controlled with prn Tylenol −HTN on amlodipine 10 and lisinopril 20 with BP 135/80 −No h/o CVD, heart failure, or DM −Non smoker −Lipids: TC 240; LDL 160; HDL 55; TG 150 •ASCVD risk? •Start aspirin? AES Question 27 28...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-004.pdf

AAFP FMX 2020

...risk of acute myocardial infarction. For severe global stress, the size of the effect was less than that for smoking but comparable with hypertension and abdominal obesity.18 Salim Yusuf, et.al. Association of psychosocial risk factors with risk of acute myocardial infarction in...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-019.pdf

AAFP FMX 2020

...•Encephalitis/encephalopathy −Viral, HTN, etc. (if you aren’t going to tap them and this is a consideration, cover them with acyclovir and abx) •Trauma •Non-convulsive status (more later) −Frontal lobe bizarre hyperactivity seizures −Supplementary motor area seizures −Frontal...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-033.pdf

AAFP FMX 2020

...• PMH: HTN-controlled on meds • Meds: HCTZ, ASA 81 mg daily • FH noncontributory • SH: former smoker, 30 pack- years • ROS: no palpitations, no GI sx • Exam: - By your office scale, 30# wt loss in 6 months. - BP 140/82. - Pulse 90. - No tremor. - No goiter. DDx • Cancer...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-039.pdf

AAFP FMX 2020

...• Type 2 Diabetes Mellitus • Insulin Resistance / Prediabetes / Metabolic Syndrome • Poorly Controlled Hypertension • Non-Alcoholic Fatty Liver Disease / Non-Alcoholic Steatohepatitis • Obstructive Sleep Apnea • Debilitating Knee/Hip Osteoarthritis • Urinary Stress Incontinence 9...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-041.pdf

AAFP FMX 2020

...groups of screening tests is appropriate for a 44-year-old man with chronic hepatitis C virus infection and clinical features of portal hypertension and cirrhosis? (Choose one) 53 54 9/10/2020 28 A. Barium swallow study and abdominal ultrasound B. MRI of the liver and...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-044.pdf

AAFP FMX 2020

...• Reduced risk / prevention of: • cardiovascular disease • thromboembolic stroke • hypertension • type 2 diabetes mellitus, • osteoporosis • obesity • colon and breast cancer • anxiety and depression • cognitive decline 7 8 More Benefits of Exercise • Improved outcomes in...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-049.pdf

AAFP FMX 2020

...edema w/o clinical, biochemical or radiologic evidence of heart failure, liver failure, nephrotic syndrome or renal failure −Loop diuretic for HTN w/concurrent urinary incontinence Age and Ageing. 2015;44:213-8 STOPP •Cardiovascular −Thiazide diuretic if • Hypokalemia •...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-050.pdf

AAFP FMX 2020

...glaucoma, macular degeneration, anxiety, COPD, and she is an active smoker with no interest in quitting because it helps her nerves, and hypertension. 9 10 Risk Factors Intrinsic • Age • Previous falls • Poor vision • Frailty - low endurance, weakness • Weight loss •...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-051.pdf

AAFP FMX 2020

...Your patient comes in for a routine check of her chronic disease. She is a 59 yo Caucasian lady with a PMH significant for hypertension, type 2 diabetes, and hyperlipidemia. She has no issue with her medication and feels overall she is doing well. Medication: Metformin 1000mg BID,...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-066.pdf

AAFP FMX 2020

...•Risk factors for vascular disease (HTN, DM2, smoking, atrial fibrillation, hyperlipidemia) •Known vascular disease (Claudication, PVD, CAD) https://upload.wikimedia.org/wikipedia/commons/b/bd/INFARCT.jpg "Bluthirnschranke nach Infarkt nativ und KM" by Hellerhoff - Own...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-072.pdf

AAFP FMX 2020

...but often worsens orthostatic hypertension • Nonpharmacologic treatment of autonomic and orthostatic symptoms is first line therapy • High salt intake, midodrine, salt-retaining steroid therapy can be useful • But supine hypertension is common, elevate head of bed at night...

Events

https://www.aafp.org/dam/AAFP/documents/events/fmx/handouts/fmx20-079.pdf

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