CME/CE Quiz

GOAL

To provide participants with current information about current blood pressure goals and effective use of antihypertensive agents to achieve these goals.

TARGET AUDIENCE

This activity is intended for physicians, medical directors, pharmacists, pharmacy directors, primary care physicians, and specialists in internal medicine and cardiology.

EDUCATIONAL OBJECTIVES

After completing this continuing education activity, the participant should be able to:

• Discuss the economic burden on the healthcare system of uncontrolled hypertension and resulting endorgan damage.
• Describe the role of RAS inhibitors in combination antihypertensive therapy.

CONTINUING MEDICAL EDUCATION ACCREDITATION

The University of Cincinnati College of Medicine designates this activity for a maximum of 2 Category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those hours that he/she actually spends in the educational activity.

The University of Cincinnati College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor medical education for physicians. Release Date: September 1, 2005. Expiration Date: September 30, 2006.

CONTINUING PHARMACY EDUCATION ACCREDITATION

Medical World Communications Office of Continuing Professional Education is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program is approved for 2 contact hours (0.2 CEUs) under the ACPE universal program number of 290-999-05-011-H04. Release Date: September 1, 2005. Expiration Date: September 1, 2006.

FUNDING

This program is supported by an unrestricted educational grant from Sankyo Pharma Inc.

CME/CE QUESTIONS

Continuing Medical Education Accreditation

The University of Cincinnati College of Medicine designates this educational activity for a maximum of 2 Category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those hours that he/she actually spends in the educational activity.

The University of Cincinnati College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor medical education for physicians.

Continuing Pharmacy Education Accreditation

Medical World Communications Office of Continuing Professional Education is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is approved for 2 contact hours (0.2 CEUs) under the ACPE universal program number of 290-999-05-011-H04.

Instructions

After reading "Healthcare Economics of Achieving JNC 7 Blood Pressure Goals in Clinical Practice," complete the program evaluation and select the 1 best answer to each of the following questions. A statement of continuing education hours will be mailed to those who successfully complete (with a minimum score of 70%) the examination at the conclusion of the program.

1. Ischemic heart disease mortality has been shown to increase linearly with age starting at systolic/diastolic blood pressures of:

• >115/>75 mm Hg
• >140/>90 mm Hg

2. Which of the following statements about the findings of the most recent National Health and Nutrition Examination Survey (NHANES) is true?

• The prevalence of hypertension is greatest among Asian Americans.
• Control of hypertension has remained the same since the previous survey.

3. Which of the following statements about blood pressure is true?

• Systolic blood pressure tends to decline with age.
• If a person's blood pressure is normal at age 55, it is likely to remain so.

4. Which of the following is not a feature of the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)?

• It emphasizes the importance of systolic blood pressure as a cardiovascular risk factor.
• It sets a blood pressure goal of <140/90 mm Hg for patients with diabetes or chronic kidney disease.

5. JNC 7 lists compelling reasons for specific classes of antihypertensive drugs. Diabetes is a compelling indication for all of the following except a(an):

• Beta blocker
• Angiotensin AT₁ receptor blocker (ARB)

6. Which of the following is not a JNC 7 recommendation about drug therapy?

• Most patients with stage 1 hypertension should receive a thiazide diurectic either alone or in combination with another agent.
• Combination therapy is often needed to get to goal blood pressure.

7. The most recent NHANES data show a hypertension control rate in the United States of 31%. The Healthy People 2010 goal is:

• 75%
• 95%

8. In 2004, the cost of hypertension in the United States was estimated to be:

• $41.5 billion
• $75.0 billion

9. Antihypertensive therapy dramatically reduces cardiovascular morbidity and mortality. The State of Health Care Quality: 2004 report showed the greatest reduction in:

• Myocardial infarction
• Heart failure

10. In a recent study of insured patients with diabetes and hypertension, the most frequently used antihypertensive agents were:

• ACE inhibitors
• Beta blockers

11. Which of the following statements is true?

• The majority of diabetic patients treated in specialized hypertension clinics achieve blood pressure goals.
• In one study, treatment to goal blood pressure in patients with diabetes increased the cost of lifetime treatment.

12. Which of the following statements is false?

• The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial showed that it is more difficult to achieve goal systolic blood pressure than goal diastolic blood pressure.
• Even patients with blood pressure regarded as optimal may be at increased risk for cardiovascular disease.

13. In the Hypertension Optimal Treatment study, about _______ were able to achieve a goal diastolic blood pressure of =80 mm Hg on monotherapy.

• 35%
• 65%

14. Which of the following statements about angiotensin II is false?

• It acts as a growth factor.
• It has indirect pressor effects.

15. Which of the following statements about ARBs is false?

• About 50% of patients treated with ARB monotherapy achieve a diastolic blood pressure of < 90 mm Hg.
• The incidence of side effects with an ARB is similar to that with an ACE inhibitor.

16. In the Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria study, about _____ of patients who received the 300-mg/day dosage achieved normoalbuminuria.

• One third
• Two thirds

17. In the Losartan Intervention For Endpoint reduction in hypertension study:

• Blood pressure reduction was greater in the atenolol group.
• The risk of stroke was greater in the losartan group.

18. The Valsartan Antihypertensive Long-term Use Evaluation showed that:

• Blood pressure reductions were similar in the losartan and amlodipine groups.
• New-onset diabetes occurred more frequently in the losartan group.

19. In a comparison of the starting doses of 4 ARBs, more patients achieved the blood pressure goal of =140/90 mm Hg in the group treated with:

• Olmesartan
• Losartan

20. Overall, clinical trials of ARBs have shown:

• A higher incidence of side effects with ARBs than with ACE inhibitors.
• Both cardiovascular and renal target-organ protection.

CE QUIZ

For Pharmacists

ANSWER CARD INSTRUCTIONS

Testing and Grading Procedures

• Each participant achieving a passing grade of 70% or higher on any examination will receive an official computer form stating the number of CE credits earned. This form should be safeguarded and may be used as documentation of credits earned.
• All answers should be recorded on the answer form. Please print clearly to ensure receipt of CE credit.

Pharmacy Times,

• Take the test online for FREE at www.pharmacytimes.com and receive immediate grading and CE credits, and download your CE statement of credit.

Please photocopy the test form for additional test takers.

Medical World Communications Office of Continuing Professional Education is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is approved for 2 contact hours (0.2 CEUs) under the ACPE universal program number of 290-999-05-011-H04. The program is available for CE credit through September 1, 2006.

Answer card and evaluation form for Pharmacists follow on page S232.

SUPPLEMENT POLICY STATEMENT

The American Journal of Managed Care

Standards for Supplements to

The American Journal of Managed Care

Journal

The American Journal of Managed Care

All supplements to are designed to facilitate and enhance ongoing medical education in various therapeutic disciplines. All supplements adhere to standards of fairness and objectivity, as outlined below. Supplements to will:

• Disclose the source of funding in at least one prominent place.
• Disclose any existence of financial interests of supplement contributors to the funding organization.
• Be up-to-date, reflecting the current (as of date of publication) standard of care.

The American Journal of Managed Care

• Publish information that is substantially different in form and content from that of the accompanying edition of The American Journal of Managed Care.
• Carry no advertising.

Publisher

's Note

The American Journal of

Managed Care

: The opinions expressed in this supplement are those of the authors, presenters, and/or panelists and are not attributable to the sponsor or the publisher, editor, or editorial board of . Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this supplement are not necessarily the same as indicated in the package insert for the product and may reflect the clinical experience of the authors, presenters, and/or panelists or may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.

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