Presentations
- Asymptomatic hypertension (HT)
- Endocrine hypertension, such as Cushing syndrome
- Hypertension emergency or urgency syndromes
Conditions
- Chronic kidney disease
- Primary hypertension:
- isolated systolic
- masked
- pseudohypertension
- resistant
- severe
- white coat
- Resistant and secondary hypertension:
- adrenal adenoma
- adrenal hyperplasia
- atherosclerotic
- dissection
- hyperaldosteronism
- kidney vascular disease
- pheochromocytoma
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a relevant clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life
Manage
- provide evidence-based management For less common or more complex presentations and conditions the trainee must also seek expert opinions
- Be familiar with and know how to prescribe anti-hypertensive medications for both acute and chronic hypertension
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Aortic coarctation
- Drug-induced hypertension
- Genetic conditions, including monogenic disorders associated with hypertension
- Kidney compression, such as Page kidney
- Obesity
- Renin-secreting tumour, such as juxtaglomerular cell tumour
- Sleep apnoea
- Syndrome of apparent mineralocorticoid excess
- Tuberous sclerosis
- Vasculitis and arteritis
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a relevant clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life
Manage
- provide evidence-based management For less common or more complex presentations and conditions the trainee must also seek expert opinions
- Be familiar with and know how to prescribe anti-hypertensive medications for both acute and chronic hypertension
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Kidney vascular disease acceleration and its effects
- Other main regulators of BP, including:
- adrenal glands
- endothelial function
- sympathetic nervous system
- Pathophysiology of HT and the cardio-renal axis Pathophysiology of hypertension:
- renin-angiotensin system (RAS)
- salt and volume control in CKD
- sympathetic system
- Pharmacology of major drug classes used to treat hypertension
- Physiological BP changes and definition of HT across age groups
- Prescribing in hypertension based on specific comorbidities, including:
- cardiovascular disease
- diabetes
- obesity
- obstructive sleep apnoea (OSA)
- psychiatric disorders
- Process of fluid and electrolyte changes due to drugs and hypertension
- Process of hormonal regulation:
- aldosterone and its link to the endocrine system
- antidiuretic hormone (ADH)
- renin-angiotensin system (RAS)
- The biomedical principles used to determine blood pressure by different devices, e.g. oscillometric sphygmomanometers The impact and risk factors of HT on the progression of kidney impairment and associated cardiovascular risk
- The life course model of health and disease to the development and treatment of hypertension
- The kidneys’ contribution to blood pressure (BP) regulation, including:
- pressure natriuresis
- renin angiotensin aldosterone system
- tubuloglomerular feedback (TGF)
- volume homeostasis
Imaging
- Echocardiography
- Kidney angiogram
- Kidney tract ultrasound
Laboratory tests
- 24-hour collections for catecholamines, cortisol
- Aldosterone and renin, including impact of medications on testing
- Kidney function and urate
- Measuring BP by different means:
- 24-hour ambulatory BP
- clinic BP
- home BP (and community)
- Salivary cortisol
- Serum catecholamines, chromogranin, and 5HIAA
- Urinalysis
Diet and lifestyle
- A <2-g/d sodium diet
- Diet low in unsaturated fats
- High-potassium diet
- Reduction in alcohol intake
- Weight loss
End-organ damage resulting from hypertension
- Coronary heart disease/myocardial infarction and heart failure
- Pregnancy in patients with organ damage
- Proteinuria
- Retinopathy
- Stroke or subarachnoid bleeding
Guidelines
- Hypertension – National Heart Foundation of Australia (NHF), Cardiac Society of Australia and New Zealand '
- KDIGO 2021 guidelines
Hypertension in special situations
- Acute kidney injury
- Adolescents
- After kidney transplantation
- Cardiac (e.g. left ventricular hypertrophy, heart failure)
- Central nervous system disease
- Nocturnal hypertension
- Pregnancy
- Race and ethnicity in considerations of BP treatment
Investigations, therapies, and prescribing
- Baroreceptor activation
- Indications for particular medications
- Mechanisms of action, benefits, and potential side effects of anti-hypertensive drug classes, and the tolerability and convenience of prescribed regimens
- Non-pharmacological measures for achieving blood pressure targets
- Thiazide effects
- Treatment modalities for renal artery stenosis (RAS)
PCH
- Age-specific dosing and delivery of antihypertensives in paediatric patients
- BP measurements in different age groups
- Standard graphs defining blood pressure values in children
