michigan hypertension core curriculum - State of Michigan

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Kevin L. Piggott, MD, MPH, FAAFP Preventive Medicine Resident, University of Michigan School of Public Health and Family Physician* Rosalind M. Peters, PhD, RN, Associate Professor, College of Nursing, Wayne State University* William Repaskey, MD, Internal Medicine Hospitalist, University of Michigan Hospitals, Ann Arbor, MI* Robert R. Ross, PA-C, Affiliate Professor, U of D Mercy PA Program Robert D. Safian, MD, Director, Cardiac and Vascular Intervention Director, Cardiovascular Fellowship Training Program, Department of Cardiovascular Medicine, William Beaumont Hospital* Ankur Sandhu MD, Nephrology and Critical Care Fellow, Henry Ford Hospital* Kiran Saraiya DO, Hypertension Nephrology Associates, PC* Linda Smith-Wheelock, ACSW, Chief Operating Officer, National Kidney Foundation of MI Hani Al-Sharif MD, Nephrology Fellow, Henry Ford Hospital* Susan P Steigerwalt MD, FACP, Director, Hypertension clinic SCSP; Member, Division of Nephrology and Hypertension, St John Hospital and Medical Center, Detroit, MI and Providence Hospital, Southfield, MI, ASH Clinical Hypertension Specialist* Radhika Thalla MD, Nephrology Consultants P.C, William Beaumont Hospital, Royal Oak, MI* Velma Theisen, MSN, RN, Manager, Heart Disease and Stroke Prevention Unit Cardiovascular Health, Nutrition and Physical Activity Section, Michigan Department of Community Health* Joel M Topf, MD, Chief of Nephrology, St Clair Specialty Physicians , Director of the Chronic Kidney Disease Clinic, St John Hospital and Medical Center* Sandra Waddell, RN, BSN, National Kidney Foundation of Michigan, Ann Arbor , MI Steven A Yarows, MD, Chelsea Internal Medicine, Michigan Hypertension Center, IHA, Adjunct Professor of Internal Medicine, Cardiovascular Division, University of Michigan Health System* Jerry Yee, MD, Henry Ford Hospital, Nephrology * Denotes contributing author 6 Hypertension Core Curriculum Acknowledgements
Produced April 2010 Permission is granted for the reproduction of this publication provided that the reproductions contain appropriate reference to the source. Made possible in part by funding from the Michigan Department of Community Health, Division of Chronic Disease and Injury Control, Cardiovascular Health, Nutrition and Physical Activity Section. Thank you to the National Kidney Foundation of Michigan’s Scientific Advisory Board. for their review and input of the Hypertension Core Curriculum. Thank you to Sheila Jackson at the National Kidney Foundation of Michigan for assisting with the design and formatting of the Hypertension Core Curriculum. NKFM & MDCH 7
Page 1: MICHIGAN HYPERTENSION CORE CURRICUL
Page 4 and 5: April 2010 Dear Colleague: In 2005,
Page 8 and 9: Blood Pressure Measurement........
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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 22 and 23: TABLE 1. Prevalence of Awareness, T
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
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Page 36 and 37: cause greater disruption of CBF aut
Page 38 and 39: References/Suggested Reading Agabit
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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
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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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