michigan hypertension core curriculum - State of Michigan

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April 2010 Dear Colleague: In 2005, the Michigan Department of Community Health (MDCH) and the National Kidney Foundation of Michigan (NKFM) convened a group of hypertension experts to identify strategies that will improve blood pressure control in Michigan. Participants included physicians from across Michigan specializing in clinical hypertension, leaders in academic research of hypertension and related disorders, and representatives of key health care organizations that are addressing this condition that afflicts over 70 million U.S. adults. The Hypertension Expert Group has focused on approaches to reduce the burden of kidney and cardiovascular diseases through more effective blood pressure treatment strategies. In an effort to improve hypertension control, the group developed educational programs on blood pressure management, diagnosis and treatment standards. The Expert Group has now turned their attention toward strengthening academic programs for health care providers in the area of clinical hypertension. It was suggested that while all universities and training programs have curricula focused on cardiovascular diseases, considerable variability exists on how each approaches the diagnosis and treatment of hypertension, in part because hypertension has not been the domain of any single medical subspecialty. Thus, our goal was to develop a state-wide core curriculum designed to serve as a comprehensive guide for updating clinical knowledge of hypertension and related disorders. This core curriculum would ensure that trainees are adequately educated, focused on a basic understanding of pressurerelated vascular pathophysiology and target-organ injury/dysfunction, optimal therapeutic strategies, and the most recent authoritative evidence-based guidelines and practice standards developed and promulgated by hypertension experts. The curriculum will be updated periodically and should continue to serve as a readily available current source for training. Sincerely, John Flack, MD, MPH Sandra Waddell, RN, BSN Chair, HTN Expert Committee Project Manager, HTN Expert Committee Wayne State University National Kidney Foundation of Michigan 4 Hypertension Core Curriculum
Acknowledgements Hypertension Expert Workgroup Committee Ziad Arabi, MD, Senior Staff Physician, Internal Medicine/Hospitalist Medicine, Henry Ford Hospital, Certified Physician Specialist in Clinical Hypertension* Aaref Badshah, MD, Chief Medical Resident, Department of Internal Medicine Saint Joseph Mercy-Oakland Hospital * Jason I Biederman DO, FACOI FASN, Hypertension Nephrology Associates, PC* Joseph Blount, MD, MPH, FACP, Medical Director, OmniCare Health Plan, Detroit, MI Mark Britton, MD, PhD, Center of Urban and African-American Health Executive Committee, Wayne State University School of medicine, Wayne State University* Paul Dake, MD, Family Medicine Residency Program Faculty McLaren Hospital Benjamin Diaczok, MD, FACP, Program Director, Department of Internal Medicine, St. Joseph Mercy Oakland Hospital* Mark D Faber MD, FACP, Program Director, Division of Nephrology and Hypertension Henry Ford Hospital, Clinical Associate Professor, Wayne State University* John M. Flack, MD, MPH, FAHA, FACP, Professor of Medicine and Physiology Chair and Chief, Division of Translational Research and Clinical Epidemiology Department of Internal Medicine, Wayne State University, Specialist in Chief for Internal Medicine, Detroit Medical Center* Editor in Chief Arthur Franke, PhD, National Kidney Foundation of Michigan, Ann Arbor, MI Crystal R. Gardner-Martin, MD, Hypertension Nephrology Associates, PC* Patricia Heiler, MPH, CHES Michigan Department of Community Health, Cardiovascular Health Section Khaled Ismail MD, Hypertension Nephrology Associates, PC* Diane Levine, MD, FACP, Associate Professor of Medicine, Vice Chair for Education Department of Internal Medicine, Wayne State University Michael Misuraca DO, Hypertension Nephrology Associates, PC* Samar A. Nasser, PA-C, MPH, Division of Translational Research and Clinical Epidemiology, Department of Internal Medicine, Wayne State University* Silas P. Norman, MD, Assistant Professor of Medicine, Division of Nephrology Section of Transplantation, University of Michigan* NKFM & MDCH 5
Page 1: MICHIGAN HYPERTENSION CORE CURRICUL
Page 6 and 7: Kevin L. Piggott, MD, MPH, FAAFP Pr
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Page 12 and 13: of the wrist. Additionally, there i
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Page 20 and 21: Masked Hypertension is when the off
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Page 36 and 37: cause greater disruption of CBF aut
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Page 42 and 43: development of essential HTN can se
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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
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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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