michigan hypertension core curriculum - State of Michigan

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and evidence that anti-hypertensive medications have increased effectiveness when paired with sodium restriction have resulted in national and international clinical guidelines calling for sodium restriction: JNC 7 recommends a sodium intake of 100 mmol (2.3 g) per day 2007 European Society of Hypertension recommends reducing sodium intake to less than 85 mmol (2 g) per day American Diabetes Association recommends sodium restriction as part of lifestyle modification which can be attempted in cases of mild hypertension prior to drug therapy or in conjunction with drug therapy for more severe hypertension K/DOQI Clinical Practice Guidelines on Hypertension and Antihypertensive Agents in Chronic Kidney Disease recommends dietary intake of less than 2.4 g (100 mmol/d) of sodium for most patients with CKD and high blood pressure The most compelling data for salt restriction concerns reduction in cardiovascular disease and mortality. Cook et al. looked at long term follow-up following two randomized controlled trials of sodium restriction in patients aged 30-54 with pre-hypertension. Patients in the intervention group were provided repeated counseling on identification of low sodium foods, and taught to monitor and reduce sodium intake. After 18 months, participants had reduced daily sodium intake by 44 mmol (1 g). The BP lowering effect of this intervention was initially modest with a reduction of 1.7/0.8 mm/Hg in the first trial and 1.2/0.7 mm/Hg in the second. The follow-up 10-15 yrs later showed that patients originally enrolled in the low-sodium group continued to demonstrate salt conscious behaviors, however no follow-up measurement of sodium intake was attempted. The interesting finding was that patients randomized to the low salt diet had a 25% (RR 0.75, 0.57-0.99) reduction in cardiovascular events and a non-significant 20% reduction in mortality (RR 0.80, 0.51-1.26, p=0.34). These are dramatic health benefits from modest reductions in sodium intake. 2 DASH diet Reduced sodium intake is well known and often advised but there are other dietary strategies to reduce BP. These include: Low fat diet High calcium intake 172 Hypertension Core Curriculum
High potassium intake High magnesium intake Vegetarian diet High fiber diet Studies that focused on a simple strategy of supplementing one of these nutrients (fiber, calcium potassium etc.) have generally been disappointing. The DASH (Dietary Approaches to Stop Hypertension) diet attempted to combine multiple dietary strategies by testing a whole diet strategy rather than an individual nutrient strategy. The DASH Trial 3 used a diet rich in fruits and vegetables to provide increased fiber and potassium along with other trace minerals. Low-fat dairy products provided increased calcium while keeping the diet low in saturated and total fat. Trial participants randomized to the DASH diet were provided meals containing 4-5 servings of fruit, 4-5 servings of vegetables, 2-3 servings of low fat dairy and
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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
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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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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 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
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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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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,
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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
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Page 208 and 209: Table 2: (JNC VII, 2004) 208 Hypert
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Page 212 and 213: ecently published RCT investigated
Page 214 and 215: Post-test question: 35y/o male w/ h
Page 216 and 217: Orthostatic Hypotension Pretest que
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Page 220 and 221: 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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