michigan hypertension core curriculum - State of Michigan

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Table 9. Assessment of worsening renal function (nephropathy) after renal revascularization Clinical Features Creatinine Acute Tubular Necrosis Hypotension and blood loss Steady and progressive rise Urinalysis Normal Normal 132 Hypertension Core Curriculum Contrast Nephropathy None None Rises within 2-4 days of procedure; peak at 7 days Distal Embolization Steady and progressive rise; may occur days or weeks after intervention Normal; Microhematuria is uncommon; eosinophils may be Urine sodium Increased Normal present Normal Urine output Oliguria Normal or oliguria Normal Correct cause, Treatment hydration Hydration Hydration Diuretics Avoid Avoid Avoid
Table 10. Classification of RAS, renal perfusion and renal parenchymal disease Type I A I B II A II B Perfusion NL* Renal ischemia NL* Renal ischemia No No Yes Yes Scr Proteinuria NL No URAS – NL BRAS – NL or ↑ No NL or ↑ May be present NL or ↑ May be present RRI < 0.7 < 0.7 > 0.8 > 0.8 Arteriolar narrowing Arteriolar pruning Cortical blood flow None None or mild Yes Yes None None Yes Yes NL NL ↓ ↓ Biopsy NL NL Abnormal Abnormal Nuclear GFR DTPA Split Function NL URAS: NL BRAS: NL or ↓ URAS: SYM BRAS: SYM URAS: ASYM BRAS: SYM or ASYM ↓ URAS: ↓ BRAS: ↓ URAS: SYM BRAS: SYM URAS: ASYM BRAS: SYM or ASYM TLG None > 20 mmHg None > 20 mmHg FFR NL < 0.8 NL < 0.8 *These patients have “anatomic” RAS, but no renal ischemia (normal perfusion) Abbreviations: Scr=serum creatinine, RRI=renal resistive index, GFR= glomerular filtration rate, DTPA= 99M -Tc-labeled pentetic acid, TLG=translesional pressure gradient, FFR=fractional flow reserve, URAS=unilateral renal artery stenosis, BRAS=bilateral renal artery stenosis, NL=normal, ↑=increased, ↓=decreased, SYM=symmetric, ASYM=asymmetric. NKFM & MDCH 133
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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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References: 1. Lewington S, Clarke
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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
Page 90 and 91: 90 Hypertension Core Curriculum Phe
Page 92 and 93: ANY patient, who develops paroxysma
Page 94 and 95: Figure 1: 94 Hypertension Core Curr
Page 96 and 97: Objectives: 96 Hypertension Core Cu
Page 98 and 99: Definition Prevalence Clinical Feat
Page 100 and 101: intake. 4 Figure 1; Ion transport i
Page 102 and 103: loading with 200 mmoles (4.6 grams)
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 112 and 113: stenosis severity. Patients with no
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Page 116 and 117: the goals of minimizing injury to t
Page 118 and 119: hemodynamically impaired renal arte
Page 120 and 121: e classified as having “renovascu
Page 122 and 123: disease of the abdominal aorta and
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 130 and 131: Table 6. Clinical evaluation of ren
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
Page 140 and 141: 78. Tami LF, McElderry MW, al-Adli
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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
Page 178 and 179: pressure: a meta-analysis of random
Page 180 and 181: 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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