michigan hypertension core curriculum - State of Michigan

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asis. National guidelines recommend every six months for calibration assessment and accuracy assessed with every use. 4. ABPM readings will be lower than those obtained using office-based ausculatory methods. Accordingly, ABPM > 135/85 mm Hg is considered to be in the hypertensive range. 5. The American Heart Association provides national recommendations for accurate BP measurement by health professionals. 6. Home BP readings can enhance management of an individuals’ hypertension, but should be implemented and monitored by a healthcare provider with adequate guidance and education provided to the patient and family. 14 Hypertension Core Curriculum
Table 1: Guidelines for Obtaining Accurate Blood Pressure Readings 2 I. Prepare the equipment: A. Use equipment that has been (1) validated as accurate against a mercury sphygmomanometer, (2) checked for disrepair of cuff (e.g., cracks or leaks in tubing, breaks in stitching or tears in fabric), (3) checked that gauge is intact (mercury meniscus or aneroid needle is at zero), (4) consistent with State Legislation. B. Obtain appropriate cuff size by measuring circumference of the patient’s arm and choosing the cuff size that corresponds to that measurement. II. Prepare the patient A. Assess (1) that patient has not recently had nicotine or caffeine and (2) that the patient has been sitting quietly for 5 minutes prior to measuring BP B. Position patient: (1) Use a sitting or semi-reclining position with the back supported and the arm at heart level (middle of the cuff should be at mid-sternum level). (2) Legs should be uncrossed with feet flat and supported on floor or foot rest (not dangling from examination table or bed) C. Bare the upper arm of any constrictive clothing (You should be able to get at least one finger under a rolled-up sleeve). Palpate brachial artery, position center of cuff bladder over the brachial artery III. Take the measurement A. Support the patient’s arm at heart level B. For ausculatory measurements: i. Obtain an estimated systolic pressure by palpation prior to auscultation ii. Inflate the cuff as rapidly as possible to maximum inflation level (30 mmHg above estimated systolic BP). iii. Deflate the cuff slowly at a rate of 2 to 3 mmHg/second; (1) note the first of 2 regular beats as systolic pressure (palpation helps to avoid under-estimating systolic pressure due to an ausculatory gap) (2) Use Kortokoff V (last sound heard) as the diastolic pressure (3) continue deflation for 10 mmHg past last sound to assure sound is not a ‘skipped’ beat. iv. The measurement should be recorded as an even number and to the nearest 2 mmHg (round upward) F. Neither the patient nor observer should talk during the measurement G. If two readings are measured, record the average of the readings IV. Record the measurement – document the following: A. The obtained BP reading B. Patient position (sitting, semi-recumbent, lying, standing) C. Arm used, include arm circumference and cuff size used D. Type of device used to obtain the measurement (mercury, aneroid, automated) E. State of the individual (e.g., anxious, relaxed) F. Time of administration of any drugs that could affect BP (*Source: 8,2,3 ) NKFM & MDCH 15
Page 1: MICHIGAN HYPERTENSION CORE CURRICUL
Page 4 and 5: April 2010 Dear Colleague: In 2005,
Page 6 and 7: Kevin L. Piggott, MD, MPH, FAAFP Pr
Page 8 and 9: Blood Pressure Measurement........
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Page 12 and 13: of the wrist. Additionally, there i
Page 16 and 17: Post-Test Questions: 1. High BP is
Page 18 and 19: 18 Hypertension Core Curriculum Ess
Page 20 and 21: Masked Hypertension is when the off
Page 22 and 23: TABLE 1. Prevalence of Awareness, T
Page 24 and 25: Blood Pressure, Circulatory Physiol
Page 26 and 27: side of the vascular tree. Arterial
Page 28 and 29: upon the other co-morbidities prese
Page 30 and 31: Table 3. Clinically Available Clues
Page 32 and 33: In the setting of chronic hypertens
Page 34 and 35: 34 Hypertension Core Curriculum Tab
Page 36 and 37: cause greater disruption of CBF aut
Page 38 and 39: References/Suggested Reading Agabit
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Page 42 and 43: development of essential HTN can se
Page 44 and 45: Figures: Figure 1. Pie-chart with m
Page 46 and 47: Table 2 Table 3 Screening Test for
Page 48 and 49: References: 1. U.S. Renal Data Syst
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Page 52 and 53: side effects particularly well. A h
Page 54 and 55: 14. Gaede P, Vedel P, Larsen N, Jen
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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
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appear to be related to access to c
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CDC MMWR Feb 24, 2006/55(07); 177-1
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Figure 1; Clinical presentation and
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90 Hypertension Core Curriculum Phe
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ANY patient, who develops paroxysma
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Figure 1: 94 Hypertension Core Curr
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Objectives: 96 Hypertension Core Cu
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Definition Prevalence Clinical Feat
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intake. 4 Figure 1; Ion transport i
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loading with 200 mmoles (4.6 grams)
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Figure 3; Endocrine Society See tex
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INTRODUCTION 106 Hypertension Core
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Renal manifestations. Renal ischemi
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to assess renal dimensions and dupl
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stenosis severity. Patients with no
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ARAS, ischemic nephropathy, and imp
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the goals of minimizing injury to t
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hemodynamically impaired renal arte
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e classified as having “renovascu
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disease of the abdominal aorta and
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Table 1. Contemporary evaluation of
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2. Screening tests for RAS RDU, MRA
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Manifestations of vital organ injur
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Table 6. Clinical evaluation of ren
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Table 9. Assessment of worsening re
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Table 11. New terminology for renal
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References: 1. Murphy TP, Soares G,
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2001;12(6):1235-1241. 40. Subramani
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78. Tami LF, McElderry MW, al-Adli
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142 Hypertension Core Curriculum Pr
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monitored hypertension screening an
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Policy Development: Public health p
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Med Clin North Am. Jan 2004;88(1):2
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mind they will have no problem iden
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Role of Race in the Selection of An
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individuals of any race or ethnicit
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Older Patients Need Elevated Systol
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sister, mother and father. A family
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ecause pressure-related retinopathy
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pulses (lower in the left arm). 4 C
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Vital signs suggestive of OSAHS. 20
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may shed light on underlying medica
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References: patients. 8 However, th
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Objectives: 170 Hypertension Core C
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and evidence that anti-hypertensive
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When subjects are given instruction
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interestingly found only a 6.0/4.6
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pressure: a meta-analysis of random
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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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