Family Medicine Clerkship

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Hypertension

OVERVIEW

Hypertension is a chronic illness that affects approximately 50 million Americans. It is a progressive chronic process that, if left untreated in the early stages, can result in serious health and mortality outcomes. The USPSTF documented that treatment of hypertension has resulted in significant decreased incidence of strokes as well as decreased mortality from coronary artery disease. Hypertension is one of the most common problems seen by family physicians. All students completing a clerkship in family medicine should have a clear understanding of the detection, treatment, and approach to patients with hypertension.

TOPIC LEARNING GOALS AND OBJECTIVES
(Organized by ACGME Competencies)

Patient Care

GOAL: Students will accurately assess blood pressure.

OBJECTIVES: Students will be able to:

• Accurately take blood pressure.
• Determine the correct blood cuff size and positions to measure blood pressure.

GOAL: Students will appropriately discuss blood pressure measurements with patients.

OBJECTIVES: Students will be able to:

• Explain blood pressure readings to their patients.
• Describe to patients how a diagnosis of hypertension is made.

GOAL: Students will be sensitive to individual and cultural differences in their development of treatment plans.

OBJECTIVES: Students will be able to:

• Discuss with patients and families the importance of lifestyle changes in the management of hypertension.
• Develop treatment plans in the context of the patient's life and environment.

Medical Knowledge

GOAL: Students will understand the significance of hypertension in health promotion and disease prevention.

OBJECTIVES: Students will be able to:

• Discuss the epidemiology of hypertension, including racial, ethnic, and socioeconomic differences.
• Describe the USPSTF recommendations for screening for hypertension.

GOAL: Students will understand the pathophysiology and risks of untreated hypertension.

OBJECTIVES: Students will be able to:

• Describe the end organ complications of untreated hypertension.
• Describe how to make the diagnosis of hypertension.
• Discuss and defend the initial evaluation of a patient with a new diagnosis of hypertension.

GOAL: Students will understand the rationale for treatment plans.

OBJECTIVES: Students will be able to:

• Describe the "step approach" to therapy.
• Discuss the evidence for the role of lifestyle changes, for example, improved diet and exercise and moderate alcohol and sodium intake.
• Discuss the side effects and costs of commonly used medications.

Practice-Based Learning and Improvement

GOAL: Students will understand the role of screening in practice settings.

OBJECTIVES: Students will be able to:

• Describe how hypertension is monitored in the clerkship site.
• Consider the impact of environment and neighborhood on adherence to treatment plans and lifestyle changes.

Interpersonal and Communication Skills

GOAL: Students will understand the importance of effective communication with patients and families in the management of this progressive, often asymptomatic, chronic illness.

OBJECTIVES: Students will be able to:

• Describe the long-term treatment plans.
• Include patients and families in the development of treatment plans.

Professionalism

GOAL: Students will appreciate that patients adhere to treatment plans in the context of their lives.

OBJECTIVES: Students will be able to:

• Demonstrate empathic discussions with patients who are not adhering to treatment plans.
• Reflect on personal frustrations and transform this response into a deeper understanding when patients are not adherent to plans.

Systems-Based Practice

GOAL: Students will understand the impact of health care systems and environment on the management of hypertension.

OBJECTIVES: Students will be able to:

• Discuss white coat hypertension
• Consider the role of other disciplines, e.g., pharmacy, nursing, social work, and allied health, in the treatment of hypertension.

EDUCATIONAL METHODS AND RESOURES

Published Material

• Douglas JG, Bakris GL, Epstein M, et al. Management of high blood pressure in African Americans: consensus statement of the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks. Arch Intern Med. 2003 Mar 10; 163(5): 525-41.
  Reference at PubMed
  
• The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA. May 21, 2003. Vol.289, No. 19
  http://www.nhlbi.nih.gov/guidelines/hypertension/

Web Sites

• Management of Hypertension Among African American Patients . Sponsored by the Association of Black Cardiologists, Inc.
  
• Palm OS and Pocket PC versions of The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)
  http://hin.nhlbi.nih.gov/jnc7/jnc7pda.htm
  
• Interactive tools and resources, such as Palm applications, from the Department of Health and Human Services and National Institute of Health - National Heart, Lung, and Blood Institute (NHLBI)
  http://www.nhlbi.nih.gov/health/prof/other/index.htm

ASSESSMENT STRATEGIES

Standardized Patient Cases

• Case - nonadherence to therapeutic plan by a Russian older male- University of Colorado
  
• Florida State University Doctoring case, Richard Usatine, MD, contact person.
  
• Medical University of South Carolina PBL case, Alexander Chessman, MD, contact person.
  
• University of California, San Francisco PBL case, Bill Shore, MD, contact person.

Lead Author: William B. Shore, MD
Clerkship/Post-Clerkship Workgroup members: Ann O'Brien-Gonzales, PhD (Chair), Alexander Chessman, MD (EC Liaison), Caryl Heaton, DO, Janice Nevin, MD, MPH, Lauren Oshman, MD, Deborah McPherson, MD, Mark. E Quirk, EdD, David Schneider, MD, MSPH, William B. Shore, MD, Richard Usatine, MD

Family Medicine Curriculum Resource (FMCR) Project HRSA Contract 240-00-0107.

For questions or comments, please contact Webmaster or Ardis Davis

This page last updated November 6, 2004