Drug Topics - January 14, 2008 - (Page 32) 32 DRUG TOPICS JANUARY 14, 2008 www.drugtopics.com CONTINUING EDUCATION An ongoing CE program of The University of Florida College of Pharmacy and DRUG TOPICS CE The University of Florida College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education ACPE # 012-99907-245-H01-P ACPE # 012-999-07245-H01-T Pharmacotherapeutic treatments for hypertension complicated with proteinuria Michael Brenner, Pharm.D., Clinical Pharmacist, Delray Beach VA Outpatient Clinic Justin Manning, Pharm.D. candidate, Palm Beach Atlantic University, Lloyd L. Gregory School of Pharmacy This lesson is no longer valid for CE credit after 1/31/10. To obtain immediate CE credit, take the test online at www.drugtopics.com. Just click on the “Continuing Education” box on the Drug Topics home page, which will take you to the CE site. Log in, find and click on this lesson, and follow the three simple steps. Test results will be displayed immediately and you can print the certificate showing your earned CE credits. The authors disclose that they have no financial relationship with any manufacturer in this area of medicine. Introduction Hypertension affects over 50 million Americans. It is a risk factor for heart disease, stroke, and kidney disease. The incidence of hypertension increases with age, but the onset most often occurs during the third, fourth, and fifth decades of life. Hypertension can be classified into two categories: primary and secondary hypertension. Primary or essential hypertension is the most prevalent, making up more than 90% of all cases and has no specific cause or symptoms. Secondary hypertension results from a known cause, which includes: chronic renal disease, renal artery stenosis, primary hyperaldosteronism, stress, sleep apnea, hyper/hypothyroidism, pheochromocytoma, pre-eclampsia, coarctation of the aorta, and it can be drug-induced. In secondary hypertension, treatment of the underlying cause is warranted before antihypertensive therapy is given. Proteinuria is one of the clinical features of renal disease and may also be secondary to diabetes. Proteinuria is classified as nephropathy (microalbumin- uria with reduced renal function) and overt nephropathy (macroalbuminuria with reduced renal function). This will be discussed in further detail after the section on pathophysiology. Patients with chronic kidney disease (CKD) and proteinuria exceeding 1gm per day are at high risk for further renal deterioration and cardiovascular disease. Reducing proteinuria will reduce progression to end-stage renal disease (ESRD), and decrease the morbidity and mortality associated with cardiovascular events. Hypertension is a well-known cause of chronic kidney disease. Blood pressure (BP) is directly proportional with proteinuria. As the BP rises, the incidence of developing proteinuria increases. Reducing BP in the presence of proteinuria and mild to moderate renal insufficiency has consistently decreased progression of kidney disease. According to the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative Working Group (NKF K/DOQI) guidelines, the goal of antihypertensive therapy for hypertension in conjunction with CKD is to decrease BP and reduce For questions concerning PRINT CEs, call (352) 273-6275. For questions concerning ON-LINE CEs, call (866) 261-3558. Photo: Jim Shive http://www.drugtopics.com http://www.drugtopics.com
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