EXCEMED Blended Education7th EMEA forum on cardiovascular risks

Amsterdam, The Netherlands24 November 2018

Dear Participants,

On behalf of EXCEMED, it is my pleasure to welcome you to the live intervention element of yourLearning Journey, 7th EMEA forum on cardiovascular risks.

This face-to-face learning experience consists of two plenary sessions and one parallel session inworking groups with frontal lectures and interactive clinical case discussions.

The learning continues after the live intervention.

Visit your Learning Journey page after the face-to-face meeting to access the in-depth interactivetutorial. We also welcome your presence in the private Facebook group which is accessible through yourpersonal Journey Page. Network with colleagues and discuss what you learned here inAmsterdam.Complete the entire journey – including the assessment surveys – and get access to a Diplomasigned by the Chair as well as the final Outcomes & Feedback Report.

We look forward to seeing you in person and online!

Yours sincerely,

Alessia AddessiSenior Programme ManagerEXCEMED

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OverviewIt is well established that high blood pressure is the most important cardiovascular risk factor andthe leading cause of death worldwide. In the near future the prevalence of hypertension willincrease worldwide despite the global effort to combat this important disease. Recent Americanand European Guidelines for hypertension have stimulated discussion about on defining moreambitious targets for antihypertensive treatment, thereby supporting the need for moreaggressive treatment. On the other hand, it is necessary to examine whether study resultssupporting the new targets, including the SPRINT trial, are truly applicable in clinical practice.Another new aspect raised by Guidelines is the primary role of fixed-dose combination therapy. Itis therefore necessary to examine all the different available combinations to understand theirdifferences and specific indications.

An EXCEMED Learning JourneyEXCEMED has designed a comprehensive Blended Learning Journey to increase knowledge incardiovascular disease with a specific focus on hypertension. This programme will address themost recent advancements of research in the area of this cardiovascular risk factor and willdiscuss the best approach for clinical management of the complex hypertensive patient in dailypractice. A multistep approach will be used, encompassing web-based and live activities. Allactivities – in-person and online – will involve the full interaction of learners.

Learning objectivesBy attending this programme, you will be able to:• Discuss the most recent indications from American and European Guidelines concerning the

blood pressure values which should be considered to start antihypertensive treatment and theblood pressure targets for therapy in patients with complicated and non complicatedhypertension.

• Personalize antihypertensive treatment by presenting the more recent novelties in thecombination therapy, including the fixed-dose based strategy and the indications to prescribe acombination of a beta-blocker with a calcium antagonist.

• Optimize the use of beta-blockers in patients with different cardiovascular complicationsincluding diabetes, coronary artery disease and heart failure.

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Target audienceThis programme is designed for cardiologists and internists involved in preventing and managingpatients with cardiovascular risk factors or who are experiencing cardiovascular diseases.

ChairGiuseppe Mancia University of Milano-BicoccaMilan, Italy

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CME ProviderEXCEMED is a non profit foundation dedicated, since the last four decades, to the development ofhigh-quality medical education programmes all over the world.

EXCEMED adheres to the guidelines and standards of the European Accreditation Council forContinuing Medical Education (EACCME®) which states that continuing medical education must bebalanced, independent, objective and scientifically rigorous.

EXCEMED - Excellence in Medical EducationSenior Programme Manager: Alessia AddessiT +39 06 420413 591 - F +39 06 420413 677alessia.addessi@excemed.org

Medical Advisor: Stefano Taddei

EXCEMED adheres to the principles of the Good CME Practice group (gCMEp).

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PREPARATORY OVERVIEWThe first exclusive tutorial is a video contribution with Professor G. Mancia (Italy) on bloodpressure targets of hypertensive patients.

Learning objectives• Define the new blood pressure target for antihypertensive treatment as defined by recent

ESH/ESC Guidelines.• Discuss the beneficial effects of such new blood pressure targets, but also the related

problems caused by tolerability and rug discontinuation.• Underline the fact that despite blood pressure normalization the residual risk of

hypertensive patients is still higher than the normotensive population.

VIDEO-LECTUREThe second contribution is a video talk by Professor G. Grassi (Italy) on sympathetic activityand hypertension.

Learning objectives• Evaluate the role of sympathetic activity in the pathophysiology of hypertension and in the

development and progression of its target organ damage• Assess the level of activation of sympathetic activity in hypertensive patients by using first

levels or advanced methods, including microneurography• Appraise the value of different antihypertensive drugs in reducing sympathetic activity

thus properly implementing patient treatment in clinical practice

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The live component of the Learning Journey is a combination of frontal lectures, panel discussionsand interactive case studies.

VenueThis conference takes place at the:Park Inn Radisson City West hotelLa Guardiaweg 59 NL-1043 DEAmsterdam, The Netherlands

LanguageThe official language of the live intervention is English.

Continuing Medical EducationThe event “7th EMEA forum on cardiovascular risks” is accredited by the European Board forAccreditation in Cardiology (EBAC®) for 5 (five) hours of External CME credits.Each participant should claim only those hours of credit that have actually been spent in theeducational activity. EBAC® works according to the quality standards of the EuropeanAccreditation Council for Continuing Medical Education (EACCME®), which is an institution of theEuropean Union of Medical Specialists (UEMS).

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FACULTY

Kennedy CruickshankDiabetes and Nutritional Sciences DivisionKing’s College LondonLondon, UK

Giuseppe ManciaUniversity of Milano-BicoccaMilan, Italy

Leonidas PoulimenosDepartment of CardiologyAsklepeion HospitalAthens, Greece

Harry A.J. Struijker-BoudierMaastricht UniversityMaastricht, The Netherlands

Brian TomlinsonDepartment of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong SAR

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Legend: L : Lecture : Discussion : Working groups

Saturday, 24 November 2018

08.15 Welcome and introductionGiuseppe Mancia (Italy)

Chair: Giuseppe Mancia (Italy)

08.30 L1: Blood pressure targets in hypertensive patients: European GuidelinesGiuseppe Mancia (Italy)

08.50 L2: Should increased heart rate be treated in hypertension?Harry A.J. Struijker-Boudier (The Netherlands)

09.10 L3: New possibilities for the fixed-dose combination treatment in hypertensionLeonidas Poulimenos (Greece)

09.30 Panel discussion

09.50 Coffee break

Chair: Giuseppe Mancia (Italy)

10.10 L4: Best practice in the management of stable chronic anginaLeonidas Poulimenos (Greece)

10.30 L5: From hypertension via the heart and arteries to heart failure: preventionstrategiesKennedy Cruickshank (UK)

10.50 L6: Use of betablockers in diabetesBrian Tomlinson (Hong Kong)

11.10 Panel discussion

Session I

Session II

PROGRAMME

11.30 Working groupsThis session includes two different parallel workshops, each lasting 45 minutes. Participants will be divided into groups and will attend both workshops in rotation. By the end of the session each participant will have attended both workshops.

WG1: Complex patient with hypertension: when we need a beta-blockerHarry A.J. Struijker-Boudier (The Netherlands)

WG2: How to optimize treatment in patients with heart failureBrian Tomlinson (Hong Kong)

Back to the plenary

13.00 Take home messages from the working groups and wrap upGiuseppe Mancia (Italy)

13.15 Closing remarksGiuseppe Mancia (Italy)

13.20 End of the live intervention

Closing lunch

Session III

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BIOGRAPHIES

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EXCEMED adheres to guidelines of the European Accreditation Council for Continuing MedicalEducation (EACCME®) and all other professional organizations, as applicable, which state thatprogrammes awarding continuing education credits must be balanced, independent, objectiveand scientifically rigorous. Investigative and other uses for pharmaceutical agents, medicaldevices and other products (other than those uses indicated in approved productlabelling/package insert for the product) may be presented in the programme (which may reflectclinical experience, the professional literature or other clinical sources known to the presenter).We ask all presenters to provide participants with information about relationships withpharmaceutical or medical equipment companies that may have relevance to their lectures. Thispolicy is not intended to exclude faculty who have relationships with such companies; it is onlyintended to inform participants of any potential conflicts so that participants may form their ownjudgements, based on full disclosure of the facts. Further, all opinions and recommendationspresented during the programme and all programme-related materials neither imply anendorsement nor a recommendation on the part of EXCEMED. All presentations represent solelythe independent views of the presenters/authors.

The following faculty provided information regarding significant commercial relationships and/ordiscussions of investigational or non-EMEA/FDA approved (off-label) uses of drugs:

Kennedy Cruickshank Declared no potential conflicts of interest.

Giuseppe Mancia Declared receipt of honoraria or consultation fees fromBoehringer, Daichi, Ferrer, Medtronic, Menarini, Merck, Novartis,Recordati, Sanofi, Servier.

Leonidas Poulimenos Declared receipt of honoraria or consultation fees from Menarini,Bayer, Astra Zeneca, Sanofi, MSD, Boehringer.

Harry A.J. Struijker-Boudier Declared receipt of honoraria or consultation fees from Merckand Servier.

Brian Tomlinson Declared receipt of grants and contracts from Amgen, MSD,Pfizer and Roche and of honoraria or consultation fees fromAmgen, Merck and Sanofi. He declared participation in acompany sponsored speakers’ bureau: Amgen and Merck.

FACULTY DISCLOSURES

Giuseppe Mancia is Professor Emeritus at theUniversity Milano-Bicocca, after being for 20years Chairman of the Division andDepartment of Internal Medicine at the sameUniversity at the San Gerardo Hospital inMonza and Director of the Interuniversity(Universities of Milano, Milano-Bicocca andPavia) Center for Clinical Physiology andHypertension. He has been Chairman(2001,2003, 2005, 2007, 2009, 2011, 2013 and2017) of the Scientific and OrganizingCommittee of ESH meetings, and pastPresident of the ISH, ESH, European Society ofClinical Investigation and Italian Society ofHypertension. He has chaired the Task Forceof the ESH/ESC Hypertension Guidelines in2003, 2007, 2009, 2013 and 2018. He iscurrently Chairman of the ESH Foundationand the Hypertension Center, Policlinico ofMonza. He is honorary member of severalhypertension and cardiovascular societies andhas received many Awards, including theHeymans Award of the International Society ofPharmacology, the Volhard and TigerstedAwards of the ISH, the Folkow Award of theESH, the International Recordati Prize, the

Invernizzi Price of Medicine, the SpinozaHonorary Professorship of the University ofAmsterdam, the Gold Medal of the LorenziniFoundation, the Honorary Professorship of theUniversity of Cordoba, a Honoris CausaDoctorate in Medicine from the University ofGdansk, Bucharest (Carol Davila) andGlasgow, the Hariri Memorial Lecture andAward and the Mac Donald Award of theMcMaster University (Hamilton). ProfessorMancia’s research focuses on theepidemiology, pathophysiology, diagnosis andtreatment of hypertension, heart failure,coronary and other cardiovascular diseases.He is interested in ambulatory blood pressuremonitoring, neural control of the circulation,large artery mechanics, hemodynamic ofcardiovascular drugs, and clinical trials.He has edited several books on hypertensionand cardiovascular diseases, and haspublished about 2400 papers in internationalJournals. His papers have received more than190.000 citations (H-index 162, MicrosoftAcademy), for which he is in the ClarivateAnalytics list of the world highly citedscientists.

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Giuseppe Mancia University of Milano-BicoccaMilan, Italy

Kennedy Cruickshank has been Professor ofCardiovascular Medicine & Diabetes at King’sCollege & consultant physician at St Thomas’& Guy’s Hospitals, London since 2011, andpreviously in Manchester, UK. He did aPhysiology BSc during medical school atBirmingham University, UK, epidemiologicalresearch training at the London School ofTropical Medicine, then a Wellcome fellowshipwith Prof George Miller at the MRC Unit andClinical Research Centre, Northwick Park, N-W London. His work on arterial functionstarted there, later showing that arterialstiffness as pulse wave velocity was a morepowerful index of prognosis than, andindependent of, blood pressure. He’d been aLecturer in Medicine for a year after MRCP inJamaica at University of the West Indies, Monaand from Northwick Park spent a further yearas visiting Senior Lecturer and ConsultantPhysician at UWI/ QE hospital Barbados. InManchester, he ran the CardiovascularClinical Trials Unit and coordinated an EUstudy on nutritional origins of high BP &diabetes between rural & urban Cameroon,Jamaica, France & Manchester and ran the

local arm of “HAPO”, the Hyperglycaemia and(Adverse) Pregnancy Outcome study, fromwhose local cohort of 2500 women manypapers arose. One used metabolomics toshow that disturbances of intermediary lipidmetabolite occur well before hyperglycaemiain T2 Diabetes and which probably define thedisease and its blood vessel damage. His research continues on the origin of ethnicdifferences in and appropriate treatment forcardiovascular disease, particularly arterialfunction and stiffness via mechanismsthrough the life course. He is President, 2016-2018, of the Artery Society,

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Kennedy CruickshankDiabetes and Nutritional Sciences DivisionKing’s College LondonLondon, UK

Harry Struijker-Boudier is emeritus Professorof Pharmacology at Maastricht University, TheNetherlands. He graduated in 1973 inPharmacochemistry and Biochemistry andobtained his Ph.D. in Pharmacology in 1975 atthe Radboud University Nijmegen, theNetherlands.Harry Struijker-Boudier worked as a post-docin the Department of Physiology andBiophysics of the University of MississippiMedical School in Jackson, Miss., USA in1976-1977 and took up a position in the newlycreated Department of Pharmacology atMaastricht University in 1977. He wasappointed as Professor of ExperimentalPharmacology in 1980 and as chairman of theDepartment of Pharmacology and Toxicologyin 1984. He spent a sabbatical year as visitingprofessor at the INSERM Unit 141 at theHôpital Lariboisière in Paris during 1991.From 1999-2006 he served as scientificdirector of the Cardiovascular ResearchInstitute Maastricht (CARIM).Harry Struijker-Boudier has published morethan 500 scientific papers in peer-reviewedinternational journals and books in the areas

of cardiovascular pharmacology, hypertension,heart failure and drug design and delivery. Thetotal number of citations of his articles is>25,000.He has served as board member of numerousinternational organizations, e.g. vice-presidentof the scientific council of the EuropeanSociety of Hypertension and board member ofthe European Federation of PharmacologicalSocieties. He is doctor honoris causa of theUniversité de Liège, Belgium, recipient of theDescartes-Huygens prize of the FrenchGovernment, member of the Dutch RoyalSociety of Sciences and Officer of the Order ofOranje-Nassau of the Dutch Royal House.

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Harry A.J. Struijker-BoudierMaastricht UniversityMaastricht, The Netherlands

Leonidas Poulimenos MD, FESC isinterventional cardiologist, head of theCatheterization Laboratory at the Departmentof Cardiology, “Asklepeion” General Hospital,Athens, Greece. He is past chairperson of theworking group on Valvular Heart Disease,Adult Congenital Heart Disease andPulmonary Hypertension of the HellenicCardiological Society. His scientific interestsare coronary artery disease (interventions andmedical management), hypertension and itsconsequences in heart and vessels, andvalvular heart disease. He is a reviewer forscientific journals and has participated inmany international clinical trials. He hasauthored many papers in peer reviewedinternational journals, and chapters in booksmainly in the fields of hypertension andcoronary artery disease.

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Leonidas PoulimenosDepartment of CardiologyAsklepeion HospitalAthens, Greece

Brian Tomlinson retired from his formerpositions as Chair Professor in theDepartment of Medicine and Therapeutics andHead of the Division of Clinical Pharmacologyat the Chinese University of Hong Kong and iscurrently Adjunct Professor in the Departmentof Medicine and Therapeutics and AdjunctProfessor in the Phase 1 Clinical Trial Centreat the Chinese University of Hong Kong. He isan Honorary Consultant Physician at thePrince of Wales Hospital, Hong Kong. Hetrained in internal medicine, ClinicalPharmacology and Clinical Toxicology at theMiddlesex Hospital Medical School andUniversity College Hospital, London andreceived his MD from the University of London,UK. He is a Fellow of the Royal Colleges ofPhysicians of London, Edinburgh andGlasgow, a Fellow of the American College ofPhysicians and a Fellow of the Hong KongCollege of Physicians and the Hong KongAcademy of Medicine.His clinical and research interests include theclinical pharmacology, toxicology andpharmacogenetics of drugs, particularly in thecardiovascular field, and the pathogenesis and

treatment of hyperlipidaemia, hypertension,the metabolic syndrome and diabetes. He hastrained over 30 postgraduate students, is anauthor of over 400 publications and over 500conference abstracts and has given numerousinvited lectures. He is a reviewer for manyjournals and serves on several EditorialBoards and is the immediate Past-Presidentof the Asian-Pacific Society of Atherosclerosisand Vascular Diseases and currentlyPresident of the Hong Kong PharmacologySociety.

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Brian TomlinsonDepartment of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong SAR

LEARNING OBJECTIVES

Learning objectives: • Describe HR targets in hypertensive patients

• Discuss which type of investigation should be performed

• Illustrate possible therapeutic strategies

• Predict the expected therapeutic benefits

H.A.J. Struijker-Boudier (The Netherlands)L2Should increased heart rate be treated inhypertension?

NOTES

Learning objectives: • Describe the relationship between blood pressure and cardiovascular risk

• Discuss the results of controlled clinical trials on cardiovascular events in hypertension

• Identify the targets proposed by the results of controlled clinical trials

• Illustrate indications of ESH/ESC Guidelines

G. Mancia (Italy)L1Blood pressure targets in hypertensive patients:European Guidelines

NOTES

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Learning objectives: • Describe the prevalence and associated cardiovascular risk of patients with stable chronic angina

• Discuss the main mechanisms leading to an established chronic coronary artery disease

• Illustrate the best therapeutic strategy according to international guidelines

• Identify specific effects of beta-blockers in coronary artery disease

L. Poulimenos (Greece)L4Best practice in the management of stablechronic angina

NOTES

Learning objectives: • Describe the difficulty of reaching blood pressure targets in hypertensive patients

• Discuss the pharmacological principles of combination therapy

• Illustrate the most important trials addressing the efficacy of different combination strategies

• Identify advantages of combinations not including RAS blockers

L. Poulimenos (Greece)L3New possibilities for the fixed-dosecombination treatment in hypertension

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Learning objectives: • Describe the relationship between diabetes and coronary artery disease

• Discuss the need to reduce coronary artery disease in diabetes

• Illustrate the metabolic effects of beta blockers

• Identify the best option among the different molecules of the class of beta-blockers

B. Tomlinson (Hong Kong)L6Use of betablockers in diabetes

NOTES

Learning objectives: • Describe different mechanisms through which hypertension can lead to heart failure

• Discuss differences between heart failure with reduced or preserved ejection fraction

• Illustrate optimal treatment according to the evidence of controlled clinical trials

• Identify the best strategy to manage follow-up

K. Cruickshank (UK)L5From hypertension via the heart and arteries toheart failure: prevention strategies

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Learning objectives: • Describe the clinical conditions of the patient

• Discuss whether a better treatment might improve prognosis

• Illustrate the best clinical approach to a specific patient

• Identify how the treatment might be improved

B. Tomlinson (Hong Kong)WG2How to optimize treatment in patients withheart failure

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Learning objectives: • Describe the clinical case of a complicated patient

• Discuss the clinical approach and differential diagnosis for this patient

• Illustrate the possible options for pharmacological treatment

• Identify clinical differences among the various molecules within the beta-blocker class

H.A.J. Struijker-Boudier (The Netherlands)WG1Complex patient with hypertension: when we need a beta-blocker

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All EXCEMED programmes are organized solely to promote the exchange and dissemination of scientificand medical information. No forms of promotional activities are permitted. There may be presentationsdiscussing investigational uses of various products. These views are the responsibility of the namedspeakers, and do not represent an endorsement or recommendation on the part of EXCEMED. Thisindependent programme is made possible thanks to educational grants received from: Merck KGaADarmstadt Germany and San Raffaele Hospital Milan.

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Continue your Learning Journey after the live intervention!

INTERACTIVE CLINICAL CASEAn interactive clinical case on heart failure will help you delve deeper into content and put thekey messages of this Learning Journey into clinical context.

Learning objectives• Describe the clinical conditions of the patient and if a better treatment might improve the

prognosis• Illustrate optimal treatment according to the evidence of controlled clinical trials• Identify how the treatment might be improved and the best strategy to manage the

follow-up

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