michigan hypertension core curriculum - State of Michigan

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controlled BP to have been victimized by “therapeutic inertia”. That is, to have repeated clinic visits with elevated BP levels noted, but with no intensification of therapy being undertaken. Also, utilization of ineffective drug combinations – beta blockers plus RAAS blockers, beta blockers and clonidine, or ACE inhibitors and ARBs – contributes to poor BP control. Drug -related factors A variety of medications and substances can raise the BP and, contribute to treatment resistance. 10 Examples include nonsteroidal anti-inflammatory drugs (NSAIDs), Selective COX-2 inhibitors, sympathomimetic drugs, oral contraceptives, and some herbal preparations. 11 While the use of these agents is fairly common, their effects are highly individualized and these agents account for only less than 2 percent of cases of resistant hypertension. 9 Nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors, impair the excretion of sodium, cause volume retention, and also inhibit the production of local renal vasodilatory prostaglandins. The therapeutic action of angiotensin-converting–enzyme (ACE) inhibitors and loop diuretics (but not calcium-channel blockers) depends on the availability of these prostaglandins. 12 At equally effective doses for osteoarthritis management, the ability on NSAID and COX2 inhibitors to destabilize hypertension control is not universally equal among all agents used 12 and. 13 The effect of acetaminophen on BP medications seems almost inert when compared to piroxicam and Ibuprofen. 14 Sulindac is one NSAID that has not been shown to affect renal prostaglandin synthesis and raise BP. Disease related factors (or secondary hypertension) Secondary causes of HTN accounts of less than 5 percent of all HTN causes 15 and up to 10 percent of cases of RH. 16 Blood pressure elevations are often more challenging to treat until the underlying secondary cause is identified and treated. Secondary causes of HTN are addressed separately under the Chapter of Secondary Hypertension. 1- Renal Parenchymal Disease: Only less than 15% of the patients with CKD who are followed in nephrology clinics achieve blood pressure control (of
especially in elderly smokers who have evidence of diffuse atherosclerotic vascular disease, an abdominal bruit, hypokalemia, a recent increase in the severity of hypertension, or an acute decline in renal function shortly after institution of therapy with an ACE inhibitor. 18 Bilateral renal artery stenosis should be suspected in patients with a history of "flash" pulmonary edema, especially if systolic heart function is preserved. 2 More than 90% of renal artery stenosis are atherosclerotic in origin; Less than 10% of renal lesions are fibromuscular in etiology developing most commonly in women,
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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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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
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 202 and 203: clonidine (Catapres†) 0.1-0.8 mg
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 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
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
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
Page 236 and 237: emergency by virtue of the associat
Page 238 and 239: PATHOPHYSIOLOGY The underlying mech
Page 240 and 241: trials included a placebo arm. Seve
Page 242 and 243: an indication for careful and modes
Page 244 and 245: ACUTE KIDNEY INJURY (AKI) In additi
Page 246 and 247: Blood Pressure Research Council, an
Page 248 and 249: [ACE inhibitors (ACEIs), angiotensi
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
Page 264 and 265: women treated with atenolol in earl
Page 266 and 267: Obstet Gynecol. Dec 12 2008. 5. Vol
Page 268 and 269: able to dissipate the pressure rise
Page 270 and 271: Use of Dihydropyridine Calcium Anta
Page 272 and 273: 272 Hypertension Core Curriculum Ca
Page 274 and 275: Case 4 Hypertensive patient with CK
Page 276 and 277: 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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