michigan hypertension core curriculum - State of Michigan

Special Populations
Introduction to Special Populations
Silas P. Norman, MD
The term Special Populations refers to the group of patients who either have hypertension (HTN) in the
setting of, or caused by other diseases. Such groups are typified by patients with diabetes mellitus,
pregnancy and members of ethnic minority groups. Treating individuals who have HTN and other
special circumstances can be especially challenging. In order to treat patients most effectively, the
practitioner must have a good sense of the confounding situation and understand how blood pressure
medications and treatments are affected by the situation. A provider must also be able to share and
coordinate care with other specialty providers when necessary to ensure the best outcomes.
In treating patients from special populations, the basic premises of HTN care remain true. The goal of
care is to minimize end-organ damage and to do so without harming the patient. Practitioners should
ideally try to utilize the fewest medications possible to achieve blood pressure goals and be conscious
of how dosing schedules and medication costs can affect medication adherence. Care should be
culturally competent and the provider should seek to engender trust in the patient-provider relationship.
In the following sections we detail a number of specific medical situations that exemplify the common
special populations and outline an approach for treatment and control of cardiovascular risk broadly
and HTN specifically in each group considered.
NKFM & MDCH 39