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Aims and Learning Outcomes

This module educates health care professionals in the management of hypertension, provide advanced qualifications for continuing medical education as well as continuing professional development

Particular emphasis is put on meeting the guidelines for the British Hypertension Society and relevant National Service Frameworks and the assessment and treatment of hypertension

Learn to
  • Evaluate theories of pathogenesis of hypertension referring to renal and vascular physiology
  • Appreciate the epidemiology of hypertension
  • Discuss the roles of age, sex, lifestyle, type of diabetes and genetics in the development of hypertension
  • Evaluate and reflect on the various hypotheses of pathogenesis of microvascular diabetic complications with special reference to renal disease as an example
  • Consider the clinico-pathological progression of diabetic nephropathy
  • Appreciate microalbuminuria as a cardiovascular (CV) and renal risk factor in Type 1 and 2 diabetes
  • Have an advanced understanding of the CV and renal outcomes of hypertension
  • Apply risk assessment to select patients for active treatment to reduce progression of renal and CV disease
  • Select evidence-based targets and interventions to prevent/slow renal disease as appropriate
  • Reflect on the role of lifestyle changes and anti-hypertensive drugs in lowering blood pressure
  • Have an advanced understanding of the mechanisms of action of the different classes of anti-hypertensive drugs
  • Develop advanced practical approaches to investigate and refer diabetic patients with renal disease
  • Manage established renal failure in diabetes in conjunction with renal services
  • Assess both hypertension and renal disease in practical case study situations and reflect on the conclusions

Course structure

  • Introduction to hypertension:
    • Scale of hypertension as a problem in developed world
    • Reducing risk, public health, role of health care professionals
    • Review of National Service Frameworks (Diabetes and Cardiology)
    • Mechanisms of hypertension
    • Secondary hypertensive disorders
    • Essential hypertension:
    • Vascular and renal hypotheses
    • Sympathetic nervous hypothesis
    • Insulin resistance: insulin as a pressor hormone.
  • Outcomes of hypertension:
    • Role of hypertension in atherogenesis
    • End organ damage as risk modifier
    • Microalbuminuria
    • Left ventricular hypertrophy
    • Review of evidence for hypertensive factors in predicting CV risk
    • Appraisal of clinical trials literature
    • Thresholds to treat hypertension based on CV risk/end organ damage
    • Modalities of treatment: evidence-based
      1. Diet and lifestyle: scope for action
      2. Different classes of anti-hypertensive drugs
      3. Stepped care or combination, old versus new drugs
      4. Specific drugs and renal disease
      5. Specific drugs and CV disease
      6. Drugs and mortality
  • Diabetic renal disease:
    • The normal kidney, structure & function
    • Microvascular complications: possible mechanisms
    • Glomerular pathology in diabetes
    • Nephropathy in Type 1 diabetes
    • Renal disease in Type 2 diabetes: alternative diagnoses
    • Screening for renal disease in clinic/practice populations
    • Investigation & management of renal disease in diabetes
    • Indications for referral: working with nephrologists
  • End stage renal disease:
    • Renal replacement treatment and its effect on CV risk
    • Use of CV risk calculation charts and understanding clinical impact of multiple risk factors
    • Application of knowledge learned: case studies
    • New frameworks for hypertension, novel agents
    • New/ongoing trials influencing practice.