Timeframe: from diagnosis until effective treatment of hypertension

Setting: inpatient setting, outpatient setting, and emergency department

Including:

identification of causes and differential diagnosis of hypertension (also malignant hypertension and emergency-related hypertension)

performance and interpretation of diagnostic modalities

interpretation of additional diagnostic modalities

medical therapy

Excluding: performing interventional or surgical procedures

hypertension during pregnancy &cenveo_unknown_entity_wingdings_F0E0; see EPA 9.8.

• Medical expert

• Communicator

• Collaborator

• Health advocate

• Professional

• Define hypertension.

• Discuss how to diagnose hypertension from:

  •   – Office measurement

  •   – Home measurement

  •   – Ambulatory blood pressure measurement

• Describe the pathophysiology of hypertension

• Describe how to differentiate primary from secondary hypertension (including causes of secondary hypertension)

• Describe the types of hypertension and potential organ damage including heart damage, with the timing of the damage and type of investigations

• Explain the use of investigations to diagnose the cardiac complications of hypertension

• Describe the blood pressure targets for antihypertensive treatment according to age and other risk factors

• Discuss non-pharmacological approaches to lowering blood pressure (e.g. lifestyle modification)

• Explain the pharmacological properties of the drugs used to treat hypertension, their indications, and side effects

• Discuss how to tailor antihypertensive treatment to the patient’s age, sex, and co-morbidities

• Define refractory hypertension

• Discuss the management of refractory hypertension

• Outline the indications for interventional and surgical treatment in hypertensive patients

• Define malignant hypertension

• Discuss the management of malignant hypertension

• Describe how to manage hypertensive emergencies

• Obtain a relevant history and perform an appropriate physical examination

• Measure and interpret BP obtained with manual and automatic office devices, and ambulatory and home BP monitors

• Perform and interpret the following diagnostic modalities:

  •   – Electrocardiogram

  •   – Exercise ECG

  •   – Echocardiography

• Interpret the following diagnostic modalities:

  •   – Comprehensive blood testing

  •   – Renal function

  •   – Proteinuria and microalbuminuria

  •   – Diabetes screening

  •   – Cardiac MR

  •   – Vascular ultrasound

  •   – Central BP assessment

  •   – Ankle brachial index

  •   – Fundoscopy

• Recognize when a patient should be referred to another speciality

• Select the target BP according to the cardiovascular risk

• Manage hypertension non-pharmacologically and pharmacologically

• Propose a roadmap to reduce global cardiovascular risk in a patient with hypertension

• Collaborate as in a team, with general practitioners and other medical specialists in the management of a patient with hypertension; in particular, the elderly and patients with diabetes, chronic kidney disease (CKD), and cerebrovascular disease

• Appreciate the systemic nature of hypertension and its consequences for various vascular beds

• Identify hypertension as major risk factor for CVD

• Demonstrate attention to detail in ensuring the adequacy of treatment and safeguarding against both under-treatment and over-treatment

• Motivate the patient to maintain long-term compliance with antihypertensive therapy and lifestyle measures and encourage the use of blood pressure home monitoring device

• Participate in hypertension prevention, detection, and treatment programmes in the community

• Direct observation/WBA (e.g. DOPS, Mini-CEX, fieldnotes)

• CbD (case-based discussion)/EbD (entrustment-based discussion)

• 5. Able to teach (no supervision)