Updating Hypertension and Cholesterol Guidelines: An Expert Interview With Joseph Saseen, PharmD, FCCP, BCPS
Editor’s note: The management of hypertension and dyslipidemia are 2 of the most common risk reduction strategies for cardiovascular disease, but national guidelines recommending standards for treatment are outdated, according to a presentation at the American Society of Health-System Pharmacists Annual Meeting 2010, held June 6 to 9 in Tampa, Florida.
For hypertension, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) was published in 2003, and is still considered the gold standard. JNC 8 is currently being compiled and is expected to be published in late 2010 or early 2011.
For dyslipidemia, the National Cholesterol Education Panel Adult Treatment Panel III (NCEP ATP III) was published in 2001, with an interim update in 2004. NCEP ATP IV should be released around the same time as JNC 8.
To learn more about the latest evidence and guidelines evaluating the management of hypertension and dyslipidemia, and how clinicians and pharmacists should effectively implement hypertension and dyslipidemia guidelines in given cases, Medscape Pharmacists interviewed presenter Joseph Saseen, PharmD, FCCP, BCPS, professor of pharmacy and medicine at the University of Colorado in Aurora.
Medscape: What is the rationale for the aggressive management of hypertension and dyslipidemia?
Dr. Saseen: Patients should be treated with recommended therapy (typically lifestyle modifications with pharmacotherapy) to reduce the long-term complications associated with these conditions. These complications include cardiovascular events and related mortality. Aggressive management can be simply treating to recommended goal values with drug therapies that are recommended owing to their proven ability to reduce these complications.
Medscape: What guidelines currently exist for the management of hypertension and dyslipidemia? How current are these?
Dr. Saseen: For hypertension, the JNC 7 guidelines are our consensus guidelines. These are quite dated; they were published in 2003. For dyslipidemia, the NCEP ATP III guidelines are even older, being published in 2001, although an update was published in 2004. These 2 are the most universally accepted guidelines for these diseases in the United States.
In the meantime, organizations such as the American Heart Association, the American Diabetes Association, and the American College of Cardiology have published more recent scientific statements, which are evidence-based recommendations for specific populations that have hypertension and dyslipidemia. These additional statements help bridge the gap between newer evidence and older guidelines.
Medscape: What evidence has been published since the most recent guidelines were issued, and how should this evidence affect the development of updated guidelines?
Dr. Saseen: There have been several long-term studies of hypertension and dyslipidemia since the publication of the JNC 7 and NCEP ATP III guidelines. Some examples of these studies are ACCOMPLISH, ON-TARGET, TRANSCEND, HYVET, the Cochrane Collaboration analysis of beta-blockers, ACCORD-BP for hypertension, and JUPITER, SPARCL, ENHANCE, ARBITER 6, and ACCORD-Lipid for dyslipidemia. These are just some of the trials that should be considered as temporary guidelines until existing guidelines are updated.
Medscape: What are the new key recommendations clinicians should follow for the management of hypertension and dyslipidemia while awaiting updated guidelines?
Dr. Saseen: Clinicians should apply newer information as appropriate, which can be a challenge because sometimes this new evidence is not completely in line with the older guidelines or requires further validation.
Medscape: What treatments do you currently recommend for hypertension?
Dr. Saseen: For patients without a compelling indication for a specific drug therapy (e.g., angiotensin-concerting-enzyme inhibitor [ACEI] or angiotensin-receptor blocker (ARB) in diabetes; beta blocker post myocardial infarction), therapy should consist of an ACEI (or ARB), calcium channel blocker, or thiazide diuretic. There is even the possibility of 2 drugs in combination for many patients.
Medscape: What treatments do you currently recommend for dyslipidemia?
Dr. Saseen: Most patients should be treated with a statin-based regimen, using a dose of a statin sufficient to reduce low-density lipoprotein by at least 30% to 40%.
Dr. Saseen has disclosed no relevant financial relationships.
Laurie Barclay, MD
From Medscape Medical News