michigan hypertension core curriculum - State of Michigan

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Post-test question: 35y/o male w/ h/o hypertension diagnosed 2 years ago presents to your clinic for a routine physical exam. He missed his last 2 appointments and admits to missing his medications up to 3-4 times per week. He is presently taking Clonidine 0.1mg BID. His blood pressure is 160/100 and HR 85. His physical exam is unremarkable. What is your next step? 1) Inform him that his noncompliance will cause a heart attack or stroke and he should take his medication as prescribed. References: 2) Increase to Clonidine 0.2mg q8hrs. 3) Stop Clonidine and initiate single pill combination therapy with a CCB and ACEi once daily, have him return in 1-2 weeks for blood pressure check and give him a prescription for a home blood pressure machine for self monitoring. (Correct answer) 4) Add a beta-blocker, metoprolol 25mg BID and have him return in 6 months. 1. Cutler JA, Sorlie PD, Wolz M, Thom T, Fields LE, Roccella EJ. Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988-1994 and 1999-2004. Hypertension 2008;52:818-27. 2. Simpson RJ, Jr. Challenges for improving medication adherence. JAMA 2006;296:2614-6. 3. Psaty BM, Furberg CD, Kuller LH, et al. Association between blood pressure level and the risk of myocardial infarction, stroke, and total mortality: the cardiovascular health study. Arch Intern Med 2001;161:1183-92. 4. Domanski M, Mitchell G, Pfeffer M, et al. Pulse pressure and cardiovascular disease-related mortality: follow-up study of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA 2002;287:2677- 83. 5. McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA 2002;288:2868-79. 6. Murray MD, Young J, Hoke S, et al. Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med 2007;146:714-25. 7. Shah NR, Hirsch AG, Zacker C, et al. Predictors of first-fill adherence for patients with hypertension. Am J Hypertens 2009;22:392-6. 8. Hsu J, Price M, Huang J, et al. Unintended consequences of caps on Medicare drug benefits. N Engl J Med 2006;354:2349-59. 9. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005;353:487-97. 10. Steiner JF, Earnest MA. The language of medication-taking. Ann Intern Med 2000;132:926-30. 11. Piette JD, Heisler M, Krein S, Kerr EA. The role of patient-physician trust in moderating medication nonadherence due to cost pressures. Arch Intern Med 2005;165:1749-55. 12. Gillespie U, Alassaad A, Henrohn D, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med 2009;169:894- 900. 214 Hypertension Core Curriculum
13. Schroeder K, Fahey T, Ebrahim S. Interventions for improving adherence to treatment in patients with high blood pressure in ambulatory settings. Cochrane Database Syst Rev 2004: CD004804. 14. Schedlbauer A, Schroeder K, Peters TJ, Fahey T. Interventions to improve adherence to lipid lowering medication. Cochrane Database Syst Rev 2004:CD004371. NKFM & MDCH 215
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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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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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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
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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Page 204 and 205: Learning Objectives 204 Hypertensio
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Page 208 and 209: Table 2: (JNC VII, 2004) 208 Hypert
Page 210 and 211: Learning objectives: 210 Hypertensi
Page 212 and 213: ecently published RCT investigated
Page 216 and 217: Orthostatic Hypotension Pretest que
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Page 220 and 221: 1- Fludrocortisone : a mineralocort
Page 222 and 223: References: 1. Hiitola P, Enlund H,
Page 224 and 225: www.neuroanatomy.wisc.edu/.../Image
Page 226 and 227: Learning objectives: 226 Hypertensi
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Page 230 and 231: Treatment of Secondary Causes of Hy
Page 232 and 233: 4-Direct vasodilators (e.g.minoxidi
Page 234 and 235: Hypertension. Aug 2003;42(2):161-16
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Page 238 and 239: PATHOPHYSIOLOGY The underlying mech
Page 240 and 241: trials included a placebo arm. Seve
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Page 244 and 245: ACUTE KIDNEY INJURY (AKI) In additi
Page 246 and 247: Blood Pressure Research Council, an
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Page 250 and 251: y sodium restriction or the use of
Page 252 and 253: 44 months 24 , and were also seen i
Page 254 and 255: • Hypertension in dialysis patien
Page 256 and 257: GISEN Group (Gruppo Italiano di Stu
Page 258 and 259: 258 Hypertension Core Curriculum
Page 260 and 261: DEFINITION AND CLASSIFICATION Hyper
Page 262 and 263: 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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