michigan hypertension core curriculum - State of Michigan

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Blood Pressure Measurement........ pp. 10 8 Hypertension Core Curriculum Table of Contents Essential Hypertension Primary Hypertension........ pp. 18 Physiological Determinants of Blood Pressure.........pp. 24 Special Populations Intro for special populations........pp. 39 Chronic Kidney Disease........pp. 40 Elderly........pp. 50 Diabetes........pp. 56 Obesity........pp. 64 African Americans........pp. 71 Hispanics........pp. 83 Secondary Hypertension Obstructive Sleep Apnea........pp. 87 Pheochromocytoma........pp. 90 Polycystic Ovary Syndrome........pp. 96 Primary aldosteronism........pp. 98 Renal Artery Stenosis........pp. 106 Prevention Public Health Approaches........pp. 145 Pervasive Hypertension Myths Hypertension is Asymptomatic........pp. 152 Race is an Important Determinant of Antihypertensive Drug Response (RAS blockers do not work in blacks, etc)........pp. 155 Older Patients Need Elevated Systolic Blood Pressures to Perfuse Their Stiff Vessels of Antihypertensive Drugs........pp. 159 Initial Evaluation........pp. 145 Treatment Lifestyle Modifications........pp. 173 Goals for the Treatment of Hypertension........pp. 182 Compelling Indications for Specific Antihypertensive Drug Classes........pp. 185 Overview of Major Antihypertensive Drug Classes........pp. 288 Principles of Combination Drug Therapy........pp. 207 Adherence........pp. 213 Treatment/Special Situations: Orthostatic Hypotension........pp. 219 Baroreceptor Dysfunction........pp. 226 Resistant Hypertension........pp. 229 Hypertensive Urgencies/Emergencies........pp. 251 Treatment of Hypertension in Patients with CKD........pp. 263 Pregnancy........pp. 263
Hypertension Management Controversies Low Diastolic Blood Pressure Should Prevent Antihypertensive Drug Therapy of Systolic Hypertension (J-Curve Debate)........pp. 271 Use of Dihydropyridine Calcium Antagonists in Chronic Kidney Disease........pp. 274 Case Studies........pp. 276 1. A hypertensive patient taking multiple antihypertensive medications with poor BP control without an appropriate diuretic prescribed. 2. A well controlled hypertensive patient with refractory hypokalemia despite replacement 3. A hypertensive patient with diabetes who is taking a diuretic and the steps that can be taken to minimize or prevent diuretic induced hyperglycemia. 4. Hypertensive patient with CKD with poorly controlled BP control experiencing a significant elevation in creatinine when BP is lowered below his goal BP. 5. A hypertensive patient who is being treated with multiple antihypertensive drugs who has significant orthostatic hypotension. 6. A hypertensive patient with truly resistant hypertension. 7. A hypertensive patient with CKD and heavy proteinuria. 8. A hypertensive patient with CKD, and proper use of diuretics appropriate to level of renal function. 9. Ms. LN returns 2 weeks after addition of an ACE-I and diuretic, and lab results reveal a reduction in EGFR. What may be the cause of the reduction in renal function, and how would you handle? 10. Ms. LN returns 4 weeks after addition of an ACE-I and diuretic, and is symptomatic. What may be causing these symptoms, and how would you handle? NKFM & MDCH 9
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 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 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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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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