michigan hypertension core curriculum - State of Michigan

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TABLE 1. Prevalence of Awareness, Treatment, and Control of Hypertension by Descriptive Factors in the REGARDS Cohort 8 All REGARDS Participants Post-test Answers Awareness of Hypertension Among All Hypertensives A 35 year old obese male comes to the office for a rash and has his routine blood pressure measured with a standard cuff of 170/104 mmHg. He has a grandfather who died of a stroke at 83 years old, but he thinks his parents are in good health and only take ‘a few’ pills. You assess the rash and indicate it is tinea crura and advise an anti-fungal cream. You then address his BP by: A. Have him return in the morning for another BP reading B. Recheck his BP with a large cuff after sitting for 5 minutes Since he is obese and just had a single reading, potentially not performed properly, it should be repeated correctly. If elevated, he should have another blood pressure check, although it does not have to be the next day, unless he has rare hypertensive urgency. (Correct answer) C. Start a diuretic and have him return for a physical D. Advise him to lose weight and see him back in a year The likelihood of isolated systolic hypertension increases in: A. Over 70 years old This is more common after 50 years of age (Correct answer) B. Under 50 years old Which of the following is true? A. Inadequate control of systolic BP is usually the reason for uncontrolled hypertension (Correct answer) B. Inadequate control of diastolic BP is usually the reason for uncontrolled hypertension C. Inadequate control of systolic and diastolic BP are equally likely in individuals with uncontrolled hypertension A 40 year old Black healthy male has been to your office twice in the past 2 months for upper respiratory infections and his average BP over these two visits was 160/102 mmHg; both BP 22 Hypertension Core Curriculum Aware of Hypertension Treatment of Hypertension Among Aware Hypertensives On Medication No. of Hypertensive Participants No. % No. aware No. % Control of Hypertension Among Treated Hypertensives Controlled Blood Pressure No. Treated No. % All Race 11 606 6023 5477 90.9 5477 4866 88.8 4858 3198 65.8 White 57.2% 3070 2738 89.2 2738 2373 86.7 2371 1663 70.1 Black 42.8% 2953 2739 92.8 2739 2493 91.0 2487 1535 61.7
eadings were higher than150/96 mm Hg. His parents are both hypertensive on medication and he used their home BP monitor with a large cuff and it was 150/96 and 164/104 mmHg. What would be your starting therapy? A. Hydrochlorothiazide (diuretic) 25mg qd B. Valsartan (angiotensin receptor blocker) 320mg qd C. Metoprolol XL (extended release beta blocker) 50mg qd D. Amlodipine (dihydropyridine calcium channel blocker) 5mg qd E. Amlodipine/lotensin (dihydropyridine calcium channel blocker + ACE inhibitor) 5/20mg qd (Correct answer) Essential Points: • Blood pressure is inherently variable within a predictable range. Hypertension is defined as elevated average BP over time, preferably with a minimum of 3 properly performed readings on different days and is never based on a single measurement o Proper measurement of BP includes that the patient is seated in a chair with a backrest and have their feet resting on the floor and be resting for a minimum of 5 minutes. Most importantly, a proper sized cuff should be used and unfortunately most Americans now need the larger cuff due to the increase in obesity. • Hypertension is classified into different categories. o Pre-hypertension are BP readings between 120-139/80-89 mmHg o Mixed systolic/diastolic hypertension is most common in middle aged patients when both the diastolic and systolic BP are elevated above 140/90 mmHg at the office. It is due to increased arteriolar resistance in the distal smaller vessels. o Isolated systolic hypertension is most common after 50 years old. It is due to increased large conduit (aorta) vessel stiffness. o Isolated diastolic hypertension is the least common and least risky hypertension phenotype. o White Coat Hypertension (office hypertension) when the patient has elevated office BP (>140/90 mmHg), however outside the office the BP is 140/90 mmHg) accounts for 77% of people who have a first stroke, 74% who have congestive heart failure, and 69% who have a first heart attack. o Normotensive men and women at 50 years of age live approximately 5 years longer than their normotensive counterparts. NKFM & MDCH 23
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........
Page 10 and 11: 10 Hypertension Core Curriculum Blo
Page 12 and 13: of the wrist. Additionally, there i
Page 14 and 15: asis. National guidelines recommend
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 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
Page 40 and 41: 40 Hypertension Core Curriculum Chr
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
Page 56 and 57: Learning Objectives: 56 Hypertensio
Page 58 and 59: glycemic risk factdors such as hype
Page 60 and 61: . Weight loss c. Weight gain d. A a
Page 62 and 63: References: 1. Association AD. All
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Page 66 and 67: foods and turn out of necessity to
Page 68 and 69: Figure 1: Table 1. Metabolic Syndro
Page 70 and 71: 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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