michigan hypertension core curriculum - State of Michigan

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Med Clin North Am. Jan 2004;88(1):223-238. 19. The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels. Results of the Trials of Hypertension Prevention, Phase I. JAMA. Mar 4 1992;267(9):1213-1220. 20. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. Jan 4 2001;344(1):3-10. 21. MacMahon S. Alcohol consumption and hypertension. Hypertension. Feb 1987;9(2):111-121. 22. Klatsky AL, Armstrong MA, Friedman GD. Red wine, white wine, liquor, beer, and risk for coronary artery disease hospitalization. Am J Cardiol. Aug 15 1997;80(4):416-420. 23. Puddey IB, Beilin LJ, Vandongen R, Rouse IL, Rogers P. Evidence for a direct effect of alcohol consumption on blood pressure in normotensive men. A randomized controlled trial. Hypertension. Sep-Oct 1985;7(5):707-713. 24. Fuchs FD, Chambless LE, Whelton PK, Nieto FJ, Heiss G. Alcohol consumption and the incidence of hypertension: The Atherosclerosis Risk in Communities Study. Hypertension. May 2001;37(5):1242-1250. 25. Hansen TW, Staessen JA, Zhang H, et al. Cardiovascular outcome in relation to progression to hypertension in the Copenhagen MONICA cohort. Am J Hypertens. May 2007;20(5):483-491. 26. Kaplan NM. Treating prehypertension: a review of the evidence. Curr Hypertens Rep. Aug 2008;10(4):326-329. 27. Bavikati VV, Sperling LS, Salmon RD, et al. Effect of comprehensive therapeutic lifestyle changes on prehypertension. Am J Cardiol. Dec 15 2008;102(12):1677-1680. 28. Svetkey LP. Management of prehypertension. Hypertension. Jun 2005;45(6):1056-1061. 29. Funk KL, Elmer PJ, Stevens VJ, et al. PREMIER--a trial of lifestyle interventions for blood pressure control: intervention design and rationale. Health Promot Pract. Jul 2008;9(3):271-280. 30. Yarnall KS, Pollak KI, Ostbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am J Public Health. Apr 2003;93(4):635-641. 31. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. Jun 26 2003;348(26):2635-2645. 32. Krahn M, Naglie G. The next step in guideline development: incorporating patient preferences. JAMA. Jul 23 2008;300(4):436-438. 148 Hypertension Core Curriculum
Pervasive Hypertension Myths Hypertension Is Not Asymptomatic John M. Flack, MD, MPH Hypertension has long been dubbed the “silent killer”. As with virtually any myth, there is typically at least a grain of truth inside the myth. Accordingly, some patients with hypertension do not have any recognizable symptoms. However, many other patients do experience symptoms, although few of the symptoms are specific to the hypertensive condition. A significant reason why many hypertension trials report that antihypertensive drugs that lower blood pressure (BP) are tolerated equivalent to placebo has to do with how BP-related symptoms are ascertained. In most pharmacological hypertension clinical trials the reported side effects/ symptoms are only ascertained when the patient volunteers that they are experiencing something unusual. However, in other trials where side effects/symptoms were ascertained at each visit, by staff blinded typically blinded to treatment status, using a sensitive side effect instrument, a different reality emerges. 1,2,3 That is, there are several lines of evidence that hypertension does cause symptoms. First, is that pharmacological treatment that lowers BP results in fewer BP-related symptoms than placebo 1 in this study 2 and others 4,5 , quality of life was also better in participants taking antihypertensive medications than placebo. Second, is that the burden of BP-related symptoms is greater at higher than lower levels of BP. 3 Finally, though this evidence is a bit more indirect, several trials have reported greater persistence on antihypertensive drug treatment than placebo 6 , an observation consistent with the occurrence of fewer side effects during active antihypertensive treatment. What complaints fall under the heading of pressure-related symptoms? Weakness, fatigue, sleep disturbance, nervousness, headache, and chest pain have all been linked to higher BP levels and, in turn, when BP levels fall, the intensity of these symptoms declines in parallel. Obviously none of these complaints either individually or even in aggregate are specific enough to diagnose hypertension by. On the other hand, when you are treating patients with hypertension it is very reasonable to query patients regarding these symptoms and to note the change in their intensity as the BP falls during treatment. There is one caveat though based on years of clinical experience that is important. Some patients feel worse before they feel better during pharmacological BP lowering. Thus, warning the patient that they may transiently feel worse before they feel better is an important strategy in preventing abrupt discontinuation of prescribed medications that are responsible for the fall in BP. In the patients NKFM & MDCH 149
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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
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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
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
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
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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 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
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Page 172 and 173: and evidence that anti-hypertensive
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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
Page 184 and 185: 3.) Beta-blockers, ACE inhibitors,
Page 186 and 187: treatment levels - albeit though at
Page 188 and 189: Preparations and Dosage: Oral antih
Page 190 and 191: Preparations and Dosages: The Oral
Page 192 and 193: patients with tachy-brady syndrome
Page 194 and 195: significant proteinuria. Pharmacolo
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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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