michigan hypertension core curriculum - State of Michigan

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Table 11. New terminology for renal vascular diseases HYPERTENSION Renovascular Hypertension: Renin-dependent hypertension, typical of young patients with FMD; characterized by high likelihood of cure of hypertension after revascularization. Essential Hypertension: Typical form of hypertension in the elderly, associated with manifestations of atherosclerosis; causal relationship between ARAS and hypertension is absent. Controlled hypertension: Blood pressure controlled with < 2 medications according to current guidelines. Refractory hypertension: Blood pressure exceeds current guidelines despite > 3 medications. Accelerated hypertension: Previously controlled hypertension becomes progressively uncontrolled, exceeds current guidelines, and remains poorly controlled despite multiple additional medications. Malignant hypertension: Uncontrolled hypertension associated with acute renal or cardiovascular injury. RENAL ARTERY STENOSIS (NO ISCHEMIA) Unilateral RAS: Anatomic unilateral RAS without objective renal ischemia Bilateral RAS: Anatomic bilateral RAS without objective renal ischemia RENAL ISCHEMIA Unilateral RAS: Objective renal ischemia in the distribution of the stenotic renal artery Bilateral RAS: Objective renal ischemia in one or both renal arteries. NEPHROPATHY (PARENCHYMAL DISEASE) 134 Hypertension Core Curriculum
Ischemic nephropathy: Renal parenchymal disease due to long-standing intrarenal arteriolar disease associated with generalized atherosclerosis. Diabetic Nephropathy: Renal parenchymal disease due to long-standing diabetes. Hypertensive Nephropathy: Renal parenchymal disease due to long-standing hypertension, intra-renal arteriolar disease, and self perpetuating hypertension Other Nephropathies: Renal parenchymal diseases associated with other known glomerular or interstitial renal diseases. Procedure Related Nephropathy: Acquired parenchymal injury (transient or permanent) that may be related to acute tubular necrosis, radiographic contrast, renal embolization, or other causes. Abbreviations: FMD=fibromuscular dysplasia, RAS=renal artery stenosis, ARAS=atherosclerotic renal artery stenosis NKFM & MDCH 135
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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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82 Hypertension Core Curriculum
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
Page 110 and 111: to assess renal dimensions and dupl
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 132 and 133: Table 9. Assessment of worsening re
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
Page 182 and 183: 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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