2007 Annual Convention & Scientific Assembly Program
Internal Medicine Section
August 6, 2007
7:00 AM - 9:00 AM
Honolulu Convention Center
Honolulu, Hawaii

Needs Assessment | Intended Audience | Learning Objectives| Faculty Disclosures | References |Program Agenda|

Needs Assessment

Cardiovascular disease remains the number one cause of death and disability in the United States, with heart disease ranking first and stroke ranking third and it is also the fastest growing disease in the
developing world.1 For this reason it is imperative that healthcare providers become more proficient at the early assessment of cardiovascular (CV) risk in their patients and implementing evidencedbased treatment strategies. The demographic profile of persons living with cardiovascular disease is no longer limited to middle-aged and older Caucasian males, CV is now also a major risk for females and most minority groups, particularly African Americans, of all ages. Although, hypertension remains one of the most common cardiovascular risk factors, it rarely presents alone. Among the people diagnosed with hypertension, more than half of them have two or more other CV risk factors such as obesity, dyslipidemia, glucose intolerance, diabetes, a family history of premature cardiovascular disease.

The dramatic changes in the clinical and demographic profile of those at risk of cardiovascular disease makes it necessary for health care practitioners to know more about early diagnose and appropriate treatment for diverse populations. Clinical trials and medical experience have shown that a multiplicative approach to risk factor management can significantly reduce poor CV morbidity and mortality outcomes. Despite the availability of multiple antihypertensive medications, hypertension control rates remain low, and the incidence of hypertension-associated cardiovascular events continues to increase.2 Only about one third of the adults with hypertension in the United States receive sufficient therapy to attain a BP of <140/90 mm HG. Control rates are particularly poor among
individuals with diabetes, with only one quarter achieving their BP level.3 Recognizing these hypertension treatment gap, the JNC-7 offer multiple strategies for improved treatment of hypertension, including emphasis on lifestyle and dietary modification and a recommendation to use thiazide diuretics in multi-drug regimens. JNC-7 also recognized that those with stage 2 hypertension (blood pressure _> 160/100 mm Hg) are likely to require >_2 antihypertensive medications to achieve blood pressure goals, and thus recommended initiation of aggressive therapy with >1 agent in this high-risk group.

Understanding the importance and use of the multiplicative approach for the management of CV should have a positive impact on the health outcomes, health status and the quality of life of persons living with CV risks, the disease or its co-morbidities, especially minorities. Individual practitioners and institutional health care providers that treat large minority patient populations must implement steps to improve the clinical management of CV by enhancing their knowledge of the clinical principles and become more proficient in techniques related to early detection, promotion, primary prevention and primary and secondary treatment for global CV risks.

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Intended Audience
Primary Care physicians, family medicine, internal medicine, residents, nurse practitioners, physician assistants and other allied health care professionals.

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Learning Objectives
At the conclusion of the program, the attendees should to able to:

1. understand risk factor assessment utilizing formal (i.e. Framingham Risk Scoring, etc.) and less formal assessment instruments and techniques;
2. recognize not only the dominant role that hypertension plays in African American patients’ risk but the important additive role of other CV risk factors such as dyslipidemia, overweight and obesity, glucose intolerance and diabetes, and other risk factors; and
3. design and applyaggressive treatment strategies early and to utilizing data from clinical trials and other evidenced-based research on which to support their clinical decision making.

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Faculty Disclosures

• ELIJAH SAUNDERS, M.D., FACC, FACP
  Grant/Research Support: Abbott, King Pharm, Norartis, Pfizer Consultant: Abbott, King Pharm, Norartis, Pfizer Speaker’s Bureau: Abbott, King Pharm, Norartis, Pfizer
• KENNETH JAMERSON, M.D.
  Research: NIH, NHLBI, NIDDK, Novartis Consultant: MSD Pfizer Novartis Speedel
• WALLACE T. JOHNSON, JR., M.D.
  Speaker’s Bureau: Pfizer, Abbott Labs, Bristol-Myers Squibb, AstraZeneca Consultant: Pfizer, Abbott Labs Grants & Research: NIH
• SHAWNA NESBITT, M.D., M.S.
  Research Support: AstraZeneca, Pfizer
  Speaker Bureau: Boerhinger Ingelheim, Novartis

The following speaker(s) declares no relationship with medical commercial companies.

• CHARLES L. CURRY, M.D., FACC, FACP
• THOMAS D.GILES, M.D.

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References

1. “Applying the Strategy of Combination Antihypertensive Therapy to Special Populations”, Giles, T., Journal of Clinical Hypertension, January 2006. Suppl. 1 Vol. 8 No.1, pg. 2.
2. “Valsartan, Blood Pressure Reduction, and C-Reactive Protein – Primary Report of the Val-MARC Trial”, Ridker, P., Danielson, E., Nader, R., Glynn, R., American Heart Association- Hypertension, May 6, 2006. 48:pgs. 73.
3. “Trends and Disparities in Coronary Heart Disease, Stroke, and Other Cardiovascular Diseases in the United States: Findings of the National Conference on Cardiovascular Disease Prevention”, Cooper, R., Cutler, J., Desvigne-Nickens, P., Fortman, S., Friedman, L., Havlik, R., Hogelin, G., Marler, John., McGoven, P., Morosco, G., Mosca, L., Pearson, T., Stamler, J., Danial, S., and Thomas, T., Circulation – Journal of the American Heart Association, 2000; 102;3137-3147.

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Program Agenda

Introduction/Program Overview
Elijah Saunders, M.D., FACC, FACP
Professor of Medicine (Cardiology)
University of Maryland School of Medicine
Baltimore, Maryland

New Definition of Hypertension-Is It Dollars or Sense- Click here
Thomas D.Giles, M.D.
Professor of Medicine
Tulane University School of Medicine
New Orleans, Louisiana

Hypertension, Dyslipidemia, Obesity in African Americans -Current Treatment Strategies- Click here
Kenneth Jamerson, M.D.
Professor of Medicine
University of Michigan School of Medicine
Ann Arbor, Michigan

DEBATE 1 - PRO AND CON - Click here
Pro - Treat BP to Goals of JNC7 and ISHIB Guidelines
Wallace T. Johnson, Jr., M.D.
Assistant Clinical Professor
Department of Medicine
University of Maryland School of Medicine
Baltimore, Maryland
Con - Treat BP to Less Than 120/80
Charles L. Curry, M.D., FACC, FACP
JBJ Professor of Medicine, Emeritus
Howard University School of Medicine
Washington, District of Columbia

DEBATE 2 - PRO AND CON- Click here
Pro - There Is A Class Effect with Anti-Hypertensive Drugs
Shawna Nesbitt, M.D., M.S.
Associate Professor of Medicine
University of Texas Southwest Medical School
Medical Director, Parkland Hypertension Clinic
Dallas, Texas
Con - There Is No Class Effect with Anti-Hypertensive Drugs
Jackson T.Wright, Jr., M.D., Ph.D., FACP
Professor of Medicine
Director, Clinical Hypertension Program
Case Western Reserve University
University Hospitals of Cleveland
Louis B. Stokes VA Medical Center
Cleveland, Ohio

DEBATE3 - PRO AND CON- Click here
Pro-There Is A Class Effect with Statin Therapy
Karol Watson, M.D., FACC
Assistant Professor of Medicine
Division of Cardiology
UCLA School of Medicine
Los Angeles, California
Con-There Is No Class Effect with Statin Therapy
Elijah Saunders, M.D., FACC, FACP
Professor of Medicine (Cardiology)
University of Maryland School of Medicine
Baltimore, Maryland