Hypertension Fellowship Curriculum

Our fellows will be involved in every aspect of the outpatient evaluation of difficult hypertension in two state-of-the-art referral clinics, one at Parkland Memorial Hospital, which serves a large indigent multiethnic population, and the other at the James W. Aston Ambulatory Care Center, which is a regional referral center for secondary causes of hypertension.

In addition, our fellows also participate fully in in-patient consultation for hypertensive urgencies at Parkland Memorial Hospital, William P. Clements Jr. University Hospital, and Zale Lipshy Pavilion—William P. Clements Jr. University Hospital.

The fellow will be required to attend and present at the following conferences:

1. Hypertension Conference:

   A formal monthly presentation that spans both clinical and basic research topics in hypertension, at which each fellow will present once a year;

2. Preventive Cardiology Conference:

   A formal monthly presentation of clinical and basic research in preventive cardiology under direction of Amit Khera, M.D., Director of the Preventive Cardiology Section, to integrate hypertension control as a vital part of cardiovascular prevention;

3. Cardiology Grand Rounds:

   A formal weekly review of cardiovascular disease research and clinical studies performed by fellows and faculty in the Cardiology Division, at which the fellow will present once a year;

4. Moss Heart Center Integrative Cardiovascular Physiology Research Conference:

   A formal weekly review of cardiovascular physiology research and clinical studies performed by fellows and faculty in the Hypertension Program, at which the fellow will present twice a year. These meetings will provide opportunities for informal peer-review from other investigators who are not directly involved in the fellow’s research.

A complete curriculum document is provided to prospective trainees upon applying to the Fellowship Program, and all trainees upon starting the Fellowship. The curriculum document includes the overall goals and objectives of the Fellowship Program, competency-based goals by which the trainees will be evaluated, specific duty and responsibilities of the trainees, outlines of the educational activities and conferences, and the research goals and requirement.

Trainees will be exposed to and will be expected to learn the following topics, which are proposed by the American Society of Hypertension educational guidelines.

• Epidemiology of hypertension
• Prevention of hypertension
• Genetics of hypertension
• Pathophysiologic mechanisms of hypertension
• Diagnostic assessment
  • Ambulatory BP assessment
  • Central aortic pressure
  • Home BP monitoring
• Metabolic abnormalities and hypertension
• Hypertensive target organ damage
• Therapy of hypertension: Lifestyle modifications and non-pharmacologic therapies
• Treatment of hypertension: Overcoming barriers to control
• Therapy of hypertension: Features of antihypertensive drugs
• Clinical trials: Methods, results, and consequences
• Hypertension in special populations
• Approach to resistant hypertension
• Hypertensive crises
• Identifiable (secondary) causes of hypertension
  • Renal parenchymal diseases
  • Renovascular hypertension and ischemic nephropathy
  • Mineralocorticoid hypertension
  • Pheochromocytoma and catecholamine-secreting paraganglioma
  • Other hormonal causes
    • Thyroid: Hypo- and hyperthyroidism
    • Hyperparathyroidism and other hypercalcemic states
    • Acromegaly
  • Other
    • Drug-induced
    • Psychogenic
    • Sleep apnea
    • Coarctation
    • Neurovascular compression

After completion of the Fellowship Program, the trainees will be exceptionally well prepared for the scientific and clinical portions of the Hypertension Specialist National Qualifying Examination, which is offered every other year by the American Hypertension Specialist Certification Program and administered by the National Board of Medical Examiners. Fellows are encouraged to enroll in the American Society of Hypertension review course to prepare for this examination.

Scholarly Activity

The training aims to cultivate research interests and develop research skills that can be applied toward a career in academic medicine. Trainees will be required to choose a research mentor among program faculty and a research project during the first month of the Hypertension Fellowship Program. All trainees must conduct at least one prospective research study under guidance of program faculty.

Fellows are expected to present their work at one of the research conferences and at a national meeting. Faculty mentors will be available to provide the project by meeting regularly with the trainees to determine progress. Our faculty have a strong commitment to the growth and development of the trainees into national leaders in clinical and translational research.

Supervision and Evaluation

The trainees will conduct outpatient consultations under the supervision of the program faculty at a weekly clinic at the James W. Aston Ambulatory Care Center and Parkland, both of which are referral centers for patients with resistant hypertension and hypertension associated with autonomic dysfunction. The trainees will also conduct inpatient consultations under the supervision of the program faculty at Parkland, Zale Lipshy University Hospital, and Clements University Hospital.

The trainees will read and interpret results of 24-hour ambulatory BP monitoring, autonomic function test, and various hormonal tests as workup for secondary causes of hypertension. 

Each member of the faculty will be required to fill out an evaluation form for each trainee after each rotation. The evaluation will be available to the trainees to review. Each trainee will meet with the program director on a quarterly basis to discuss the individual’s progress and specific suggestions for improvement.

The trainees will receive a written report including the evaluation, recommendations, and results of the discussion. The written report must be signed by the trainee and the program director and is permanently placed in the trainee’s file.

Progressive Nature

Fellows who seek more intense training in basic or clinical hypertension research to position themselves more competitively for a faculty position at an academic medical center may need two years to complete training. During the second year, the fellows will spend no less than 60 percent of their time in clinical care. No more than 40 percent of the time will be in research.

Goals for clinical skills for second year fellows include the following:

1. Acquiring skills

   Acquiring skills in treatment of not only hypertension but also orthostatic hypotension, which is a coexisting problem in many elderly patients with abnormalities in autonomic control of blood pressure such as Parkinson’s disease, diabetes mellitus, and other neurodegenerative diseases. The second-year fellows will acquire a deeper understanding of neurohormonal control of circulation and learn how to control hypertension without exacerbating orthostatic hypotension. The second-year fellows will be expected to generate a preliminary report on autonomic function testing (cold pressor test, Valsava test, etc).

2. Improving skills in interpretation

   Improving skills in interpretation of variety of tests necessary for workup of secondary hypertension such as adrenal vein sampling, salt loading tests, and clonidine suppression tests. The second-year fellows will be expected to generate a preliminary report and incorporate these results in clinical recommendation and patient care.

3. Improving skills in treatment

   Improving skills in treatment of complex hypertension such as secondary hypertension, hypertension with side effects to multiple medications, labile hypertension, through additional repetition.

4. Formulating research

   Formulating their own research proposal under the guidance of faculty and submit their grant proposals to American Heart Association (postdoctoral grant) or National Institute of Health (NRSA or K award).