michigan hypertension core curriculum - State of Michigan

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Table 6. Clinical evaluation of renal artery perfusion and renal ischemia Noninvasive assessment of renal blood flow 125 I-Iothalamate GFR (Total GFR) 99M Tc-DTPA (Split renal function and single-kidney GFR) Invasive assessment of significance of RAS Percent diameter stenosis by visual estimates or quantitative angiography Translesional pressure gradient (TLG) Fractional flow reserve (FFR) Intravascular ultrasound (IVUS) Renal frame counts (RFC) Renal blush score (RBS) Abbreviations: GFR= glomerular filtration rate, RAS=renal artery stenosis, 99M Tc-DTPA= technetium- labeled pentetic acid. Table 7. Technical considerations to avoid renal injury during renal stenting Avoid injury to renal artery ostium Minimize catheter manipulation No-touch technique (Figure 8) Catheter-in-catheter technique (Figure 8) Minimize contrast nephropathy Hydration Limit contrast volume Prevent distal embolization Distal embolic protection devices (?) Glycoprotein IIb / IIIa inhibitors (?) 130 Hypertension Core Curriculum
Table 8. Causes of failure of renal revascularization Failure to improve / cure hypertension Stenosis is not hemodynamically significant (no renal ischemia) Hypertension is “essential,” not “renovascular” Renal parenchymal disease and self-perpetuating hypertension Intra-renal vascular disease Suboptimal revascularization result Failure to improve / stabilize renal function Stenosis is not hemodynamically significant (no renal ischemia) Inability to detect improvement using serum creatinine Pre-existing renal parenchymal disease Contrast nephropathy Renal embolization Acute tubular necrosis NKFM & MDCH 131
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MICHIGAN HYPERTENSION CORE CURRICUL
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April 2010 Dear Colleague: In 2005,
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Kevin L. Piggott, MD, MPH, FAAFP Pr
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Blood Pressure Measurement........
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10 Hypertension Core Curriculum Blo
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of the wrist. Additionally, there i
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asis. National guidelines recommend
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Post-Test Questions: 1. High BP is
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18 Hypertension Core Curriculum Ess
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Masked Hypertension is when the off
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TABLE 1. Prevalence of Awareness, T
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Blood Pressure, Circulatory Physiol
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side of the vascular tree. Arterial
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upon the other co-morbidities prese
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Table 3. Clinically Available Clues
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In the setting of chronic hypertens
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34 Hypertension Core Curriculum Tab
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cause greater disruption of CBF aut
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References/Suggested Reading Agabit
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40 Hypertension Core Curriculum Chr
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development of essential HTN can se
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Figures: Figure 1. Pie-chart with m
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Table 2 Table 3 Screening Test for
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References: 1. U.S. Renal Data Syst
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50 Hypertension Core Curriculum Spe
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side effects particularly well. A h
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14. Gaede P, Vedel P, Larsen N, Jen
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Learning Objectives: 56 Hypertensio
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glycemic risk factdors such as hype
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. Weight loss c. Weight gain d. A a
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References: 1. Association AD. All
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64 Hypertension Core Curriculum Spe
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foods and turn out of necessity to
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Figure 1: Table 1. Metabolic Syndro
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9. Singh GK, Kogan MD, Van Dyck PC,
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Incidence and Prevalence The overal
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access to healthy foods than their
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As a part of the approach to managi
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B Hypertensive Adults (rate, percen
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Page 84 and 85: appear to be related to access to c
Page 86 and 87: CDC MMWR Feb 24, 2006/55(07); 177-1
Page 88 and 89: Figure 1; Clinical presentation and
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Page 92 and 93: ANY patient, who develops paroxysma
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Page 98 and 99: Definition Prevalence Clinical Feat
Page 100 and 101: intake. 4 Figure 1; Ion transport i
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Page 104 and 105: Figure 3; Endocrine Society See tex
Page 106 and 107: INTRODUCTION 106 Hypertension Core
Page 108 and 109: Renal manifestations. Renal ischemi
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Page 116 and 117: the goals of minimizing injury to t
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Page 120 and 121: e classified as having “renovascu
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Page 124 and 125: Table 1. Contemporary evaluation of
Page 126 and 127: 2. Screening tests for RAS RDU, MRA
Page 128 and 129: Manifestations of vital organ injur
Page 132 and 133: Table 9. Assessment of worsening re
Page 134 and 135: Table 11. New terminology for renal
Page 136 and 137: References: 1. Murphy TP, Soares G,
Page 138 and 139: 2001;12(6):1235-1241. 40. Subramani
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Page 144 and 145: monitored hypertension screening an
Page 146 and 147: Policy Development: Public health p
Page 148 and 149: Med Clin North Am. Jan 2004;88(1):2
Page 150 and 151: mind they will have no problem iden
Page 152 and 153: Role of Race in the Selection of An
Page 154 and 155: individuals of any race or ethnicit
Page 156 and 157: Older Patients Need Elevated Systol
Page 158 and 159: sister, mother and father. A family
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Page 162 and 163: pulses (lower in the left arm). 4 C
Page 164 and 165: Vital signs suggestive of OSAHS. 20
Page 166 and 167: may shed light on underlying medica
Page 168 and 169: References: patients. 8 However, th
Page 170 and 171: Objectives: 170 Hypertension Core C
Page 172 and 173: and evidence that anti-hypertensive
Page 174 and 175: When subjects are given instruction
Page 176 and 177: interestingly found only a 6.0/4.6
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isolated systolic hypertension have
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Compelling Indications for Specific
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3.) Beta-blockers, ACE inhibitors,
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treatment levels - albeit though at
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Preparations and Dosage: Oral antih
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Preparations and Dosages: The Oral
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patients with tachy-brady syndrome
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significant proteinuria. Pharmacolo
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the effect found by the ACE inhibit
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and nominally statistically signifi
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sensitive K+-channels in vascular s
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clonidine (Catapres†) 0.1-0.8 mg
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Learning Objectives 204 Hypertensio
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general, the response to beta-block
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Table 2: (JNC VII, 2004) 208 Hypert
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Learning objectives: 210 Hypertensi
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ecently published RCT investigated
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Post-test question: 35y/o male w/ h
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Orthostatic Hypotension Pretest que
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BP. It is important to note that la
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1- Fludrocortisone : a mineralocort
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References: 1. Hiitola P, Enlund H,
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www.neuroanatomy.wisc.edu/.../Image
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Learning objectives: 226 Hypertensi
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controlled BP to have been victimiz
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Treatment of Secondary Causes of Hy
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4-Direct vasodilators (e.g.minoxidi
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Hypertension. Aug 2003;42(2):161-16
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emergency by virtue of the associat
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PATHOPHYSIOLOGY The underlying mech
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trials included a placebo arm. Seve
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an indication for careful and modes
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ACUTE KIDNEY INJURY (AKI) In additi
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Blood Pressure Research Council, an
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[ACE inhibitors (ACEIs), angiotensi
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y sodium restriction or the use of
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44 months 24 , and were also seen i
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• Hypertension in dialysis patien
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GISEN Group (Gruppo Italiano di Stu
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258 Hypertension Core Curriculum
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DEFINITION AND CLASSIFICATION Hyper
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etween adult socioeconomic position
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women treated with atenolol in earl
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Obstet Gynecol. Dec 12 2008. 5. Vol
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able to dissipate the pressure rise
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Use of Dihydropyridine Calcium Anta
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272 Hypertension Core Curriculum Ca
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Case 4 Hypertensive patient with CK
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Case 6 276 Hypertension Core Curric
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year. Sodium restriction and weight
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What may be causing these new sympt
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