Chair I: Anatomy and physiology of the arterial wall and target organs of vascular disease
Module on normal and pathological anatomy
Based on the micro- and macroscopic study of the vascular system and its target organs. Initial step towards an integrative understanding of normal and pathological physiology.
Thematic units
- Normal and pathological anatomy and histology of blood vessels.
- Anatomy, histology, and normal and pathological ultrastructure of the heart. Anatomical and ultrastructural characteristics of left ventricular fibrosis and hypertrophy. Differences from normal myocardium. Coronary circulation. Heart disease: pathological findings.
- Normal and pathological anatomy, histology, and ultrastructure of the central nervous system. Cerebral circulation.
- Normal and pathological anatomy, histology, and ultrastructure of the renal system.
- Anatomy, normal and pathological histology of the adrenal, thyroid, and parathyroid glands.
- Research: methodology for conducting anatomical studies in hypertension.
Practical work involves studying anatomical specimens in the anatomy room, and histological specimens using optical-electron microscopy, anatomo-clinical conferences, and the methodology of etio-anatomo-clinical study.
Physiology and Pathophysiology Module
Module objectives: The endothelial cell is the common factor affected in vascular diseases. The study of its functions, along with a thorough understanding of the mechanisms of normal and pathological blood pressure regulation, is crucial.
Thematic units
- Regulation of blood pressure under normal and pathological conditions.
- Arterial wall and biomolecular factors that determine systolic, diastolic, mean, pulse, etc. blood pressure.
- Normal and pathological endothelium. Basic and clinical evaluation methodology.
- Oxidative stress: basic and clinical assessment methodology.
- Renal physiology and pathophysiology. Mechanisms linked to arterial hypertension.
- Autonomic nervous system. Methods of measurement and evaluation.
- Calcinosis: modulation; pathophysiological aspects. Potassium and arterial hypertension. Natriuretic peptides: types, receptors, mechanisms of action. Adrenomedullin. New neurohumoral factors.
- Systemic hemodynamics and regulation of regional blood flow. Autoregulation.
- Membrane transport mechanisms. Active and passive transmembrane transport. Cotransport and countertransport. Cell membrane pumps: Na/K; Na/H; Na/Li.
- Mineralocorticoids: role of aldosterone in hypertension and target organ damage. Prostaglandins. Vasopressin.
- Insulin resistance and hyperinsulinemia. Mechanisms. Effects on blood pressure.
- Genetics of hypertension. Basic concepts of molecular genetics. Monogenic and polygenic inheritance. Genetic patterns: genotypes and phenotypes. Genetics of the renin-angiotensin-aldosterone system. Elementary notions of gene therapy and pharmacogenomics.
Practical work includes laboratory studies of Basic and Applied Clinical Physiology, and is discussed in clinical-physiopathological seminars.
Chair II: vascular biomechanics
It provides the student with the theoretical and practical tools to analyze bioengineering perspectives in vascular function.
Thematic units
- History of knowledge of arterial mechanics.
- The vascular system as a hydraulic model. The circulatory network, the vascular wall, and the cardiovascular system. Biomechanics of the arterial wall: wall modules. Cardiovascular regulation.
- Modeling the vascular wall: example; Windkessel model, models in rigid and deformable ducts. Stress-strain relationship.
- Properties of liquid and solid systems.
- Fluid dynamics. Applied physics.
- Hemorheology. Quantitative hemodynamics: determinants of arterial load (distensibility, resistance, reflected wave). Calcinosis.
- Mechanical basis of arterial wall function and structure, signal digitization, clinical evaluation methodologies. Compliance, variability, plethysmography. Experimental determinations of pressure and flow, concept of hysteresis.
Practical work includes the study and modeling of engineer-driven systems, and the practice of clinical evaluation techniques necessary to develop an interdisciplinary vascular studies laboratory. Application of bioengineering to case interpretation.
Chair III: clinic
Anamnesis and Semiology Module
Objective: To train the professional for a holistic and integrative evaluation of the patient.
Classifications, analysis, methodology. Stratification. Epidemiology. Natural history. Personal and family history. Semiology of vascular diseases, essential and secondary hypertension. Anthropometry.
Measurement module
This involves teaching and explaining the technique, the scope and limitations of the methods; interpreting diagnostic and prognostic information.
- Methodology and fundamentals. Techniques. Equipment, from clinical and engineering perspectives. Equipment validation and calibration (BHS and AAMI rules). Office blood pressure measurement, self-measurement. Hypertension and the white coat phenomenon. Its analysis in clinical studies. Inter- and intra-office variability, short- and long-term, day-night. Evaluation with Finapres and Portapres.
- Automated ambulatory blood pressure monitoring. Indications. Evaluation of results and report generation. Equipment validation (BHS and AAMI rules). Blood pressure patterns over 24 hours: dipper, non-dipper, and hyperdipper/peaker patterns. Evaluation of variability, pulse pressure, and blood pressure characteristics, their rationale and utility. Prognostic and diagnostic value of the hypertensive burden.
Practical work includes studying equipment structure from an engineering perspective, practicing technical methodologies, interpreting and processing results, and training for participating in research studies. Interactive workshops.
Applied diagnostic methodology module
It is based on training for its execution, interpretation of the data provided by complementary methods and its prognostic projection.
- Conventional, specific, biomolecular laboratory. Methodology.
- Electrocardiogram. Radiology. Fluorescein retinography. Abdominal ultrasound. Transcranial renal Doppler assessment.
- Intima-media thickness. Echocardiography, tissue Doppler, backscattering.
- Computed tomography, magnetic resonance angiography. Utility and contributions. Evaluation of the central nervous system. Evaluation of abdominal masses and incidental findings.
- Arteriography: results, methodology, and interpretation. Renal venipuncture, lateralization. Nuclear medicine: radiorenogram. Diagnostic utility and prognosis.
- Common and sensitized tests. Cardiac evaluation: usefulness of ventriculography and myocardial perfusion studies in arterial hypertension. Special tests: hyperaldosteronism, thyroid dysfunction, pheochromocytoma.
It is a module with a high practical content in which you participate in the carrying out and interpretation of the studies.
Secondary hypertension module
It provides the necessary tools for the diagnostic, prognostic, and therapeutic evaluation of secondary arterial hypertension.
- Nephroparenchymal hypertension: causes; pathophysiology; diagnosis and treatment. Pathophysiology and treatment of hypertension in dialysis patients. Renal vascular hypertension: causes; pathophysiological basis; diagnosis. Medical and invasive treatment: indications. Prognosis.
- Pheochromocytoma: familial type; classification; locations; diagnostic studies; medical and surgical treatment.
- Primary hyperaldosteronism: congenital adrenal hyperplasia and adrenal adenoma; concept of idiopathic hyperaldosteronism. Genetic forms of hyperaldosteronism. Diagnosis. Medical and surgical treatment.
- Cushing's syndrome: mechanisms; diagnosis and treatment.
- Thyroid: Mechanisms of arterial hypertension in hyperthyroidism and hypothyroidism. Diagnostic evaluation and treatment.
- Coarctation of the aorta: etiopathogenesis; diagnosis; treatment.
- Sleep apnea: etiopathogenesis; diagnostic studies; specific and hypotensive treatment.
- Other causes of secondary hypertension. Etiopathogenic mechanisms. Diagnosis and treatment. Alcoholism and hypertension. Hypertension in transplant patients. Drugs and hypertensive substances.
Special situations module
- High blood pressure in the elderly.
- Hypertension in obese patients. Pathophysiology: renal mechanisms; insulin resistance; sympathetic activation. Clinical evaluation. Treatment: preferred drugs. Dietary aspects. Complications. Prognosis.
- Borderline hypertension. Definition. Mechanisms. Diagnostic evaluation. Prognosis.
- Hypertension and diabetes. Pathophysiological mechanisms involved. Special diagnostic studies. Special aspects of pharmacological treatment: preferred drugs. Therapeutic objectives. Prevention of diabetes and antihypertensive treatment: bibliographic evidence. Literature review. Common complications: diabetic nephropathy; retinopathy; peripheral neuropathy. Their importance in the hypertensive patient. Prevention.
- Hypertension and coronary artery disease. Functional assessment. Specific therapeutic aspects. Mechanisms of myocardial involvement in the hypertensive patient.
- Hypertension and the central nervous system. The stroke patient: pathophysiological mechanisms. Chronic and acute cerebrovascular involvement in hypertension. Role of hypertension in ischemic and hemorrhagic stroke. Diagnosis. Primary and secondary prevention of stroke. Hypotensive treatment in acute stroke. Subarachnoid hemorrhage. Parenchymal pathology and hypertension. Treatment of hypertension in patients with intracranial hypertension. Vascular dementias.
- Gestational hypertension. Definition. Classification. At-risk populations. Diagnostic evaluation. Prognostic criteria. Treatment. Preeclampsia. Eclampsia. Hypertension in the immediate postpartum period. Prognostic value of gestational hypertension.
- Hypertension in children and adolescents. Diagnostic criteria. Percentiles. Evaluation of the hypertensive child. Indications for secondary hypertension studies. Blood pressure monitoring in children and adolescents. Special aspects of antihypertensive treatment: drugs; dosage. Hypertension in the newborn: particular considerations. The child of hypertensive parents: follow-up and prognosis.
- Hypertension in Black Individuals. Epidemiology. Prevalence. Differential Pathophysiological Aspects. Specific Diagnostic and Therapeutic Criteria. Mechanisms of Target Organ Damage in Black Individuals. Prognosis.
Internships are conducted through gestational hypertension, pediatrics, geriatrics and diabetes services and through the outpatient clinic for arterial hypertension.
Severe hypertension module
- Classification. Epidemiology. Causal and predisposing factors.
- Semiology. Criteria for admission and transfer to intensive care units. Initial measures.
- Home and hospital management of severe isolated hypertension. Clinical practice guidelines.
- Hypertensive emergencies and clinical emergencies associated with hypertension.
Interdisciplinary study module. Design of a vascular medicine laboratory
- The characteristics of a vascular laboratory are presented, its objectives, operation and practical aspects for its design, organization and implementation.
- From semiology to disease identification. Concepts of clinical vascular homeostasis.
- Integrative clinical assessment of the manifestations of vascular disease.
- Multidisciplinary work: what each person contributes, and how. Role of complementary methods: assessment of the arterial wall, stenotic lesions, and functional alterations.
- Indications. Implications for treatment and prevention.
- Vascular research laboratories in Argentina and Spain.
Chair IV: therapy
Non-pharmacological treatment module
- Salt and hypertension. Low-sodium diet. Hypotensive mechanism. Sodium/potassium balance. Relationship of dietary sodium to the development and progression of hypertension. Population studies.
- Weight reduction. Clinical experience. Additional beneficial effects. Weight and prognosis. Importance of weight gain. Waist circumference and cardiovascular risk.
- Physical activity. Indications. Differences between the effects of aerobic and anaerobic exercise. Additional benefits. Limitations. Effects of antihypertensive treatment on aerobic capacity.
- Other non-pharmacological measures. Calcium, potassium, and/or magnesium supplements. Macronutrients. Smoking and hypertension. Caffeine and hypertension. Relaxation techniques. Probable hypotensive mechanisms involved. Available clinical evidence.
- DASH Diet. Main characteristics. Indications. Clinical evidence. Additional benefits.
Module on objectives and methods of evaluation of antihypertensive treatment
- Indication for pharmacological treatment. Rationale. Epidemiological and experimental basis. Treatment adherence. Causes of non-adherence: related to the physician, the patient, or the drug. Probable solutions. Variability in individual response to drugs.
- Objectives of antihypertensive treatment. Difficulties and possibilities.
- Resistant or refractory and pseudo-resistant hypertension. Causes. Management of the treatment-resistant patient. Diagnostic evaluation.
- Evaluation of drug action time. Utility of blood pressure monitoring. Trough-peak ratio. Smoothness Index. Importance of the morning blood pressure rise in drug selection.
- Pharmacoeconomics. Economic impact of hypertension. Cost-benefit analysis of antihypertensive treatment.
Module on basic concepts of general pharmacology
- Basic notions of pharmacology.
- Pharmacokinetics and pharmacodynamics.
- Absorption, metabolism and elimination of drugs.
- Drug interactions.
- Dosage. Dose-response curves.
- Drug approval mechanisms: rules of FDA, EMEA, ANMAT and other agencies.
- Generic and similar medicines. Pharmaceutical and therapeutic equivalence.
- Concept of bioavailability and bioequivalence.
Pharmacological treatment module
Each drug family and each individual drug will be studied for its pharmacokinetics, pharmacodynamics, antihypertensive efficacy and beneficial effects in the management of vascular disease, available clinical evidence, indications, contraindications, and interactions.
- Diuretics.
- Beta blockers.
- Alpha blockers.
- Inhibitors of the converting enzyme.
- Angiotensin AT1 receptor blockers.
- Calcium antagonists.
- Centrally acting drugs.
- Other antihypertensive drugs: renin inhibitors; anti-endothelin drugs; endopeptidase inhibitors; imidazole receptor blockers; potassium channel blockers; dopamine agonists. Peripheral vasodilators: current use.
- Drug combinations: effective combinations. Clinical utility. Advantages and disadvantages. Fixed and elective combinations. Pathophysiological basis of treatment with drug combinations.
- Usefulness of hypoglycemic and hypolipidemic drugs in antihypertensive treatment. Clinical evidence. Effects on the endothelium and insulin resistance. Aspirin and hypertension.
- “Beyond Hypertension”: Non-hypotensive effects of antihypertensive drugs. Proven and hypothetical evidence. Potential use in cardiovascular therapy.
- Treatment of high blood pressure in special situations: heart failure; coronary artery disease; kidney failure; transplant patients; atrial fibrillation and other clinically significant cardiac arrhythmias.
Cardiovascular primary prevention module
- Public Health. Health promotion and prevention. The patient, the community. Prevention methods: how to influence behaviors and actions that promote health or disease. Dietary habits, fads, and trends.
- Influence of lifestyle. Psychosocial determinants of behavior: income, opportunities, and education; difficulties in changing habits. Behavioral patterns; Rosenman and Friedman classification. Humiliation and ignominy; hostility and the anger-hostility complex; alexithymia; depression. Social determinants
- Epidemiology and demography. Population pyramid; mortality rate; survival tables; age and sex distribution of mortality. Cardiovascular mortality. Sex differences. Historical trends in cardiovascular mortality.
- Risk factors. Association and causality; strength of association, consistency, chronological relationship, specificity, biological reasonableness, coherence, experimental correlation. Modifiable, eradicable, causal, conditional, predisposing factors. Relative risk and absolute risk. Concept, estimation, and stratification of absolute coronary risk. New coronary risk factors. Emerging risk factors. Homocysteine. Lipoprotein(a). Fibrinogen. Factor VII. Tissue plasminogen activator inhibitor. C-reactive protein.
- Risk factors in childhood and adolescence.
- Obesity. Metabolic syndrome.
- Intrauterine growth retardation. Prenatal introduction of risk.
- Early rebound of adiposity. Fetal hypothesis of coronary artery disease.
- Primary prevention. Type and value of dietary regimens. Antiplatelet and antithrombotic treatment, lipid-lowering agents, fibrates and resins in primary prevention, pharmacological and non-pharmacological treatment of hypertension in primary prevention (smoking cessation and interventions to stop smoking, reduced salt intake, exercise, weight loss, reduced alcohol intake, dietary interventions, drugs).
- Secondary prevention.
Chair V: research methodology
- Research methodology is a fundamental tool of the master's program. It will not only enable you to design your own project but also equip you to critically analyze the studies presented to you.
Thematic units
- The research question. Types of studies. Stages of a research project.
- Measures of disease frequency and measures of the effect of a risk factor or treatment. Concept of confounding/interaction effect and bias.
- Study designs: etiological, cross-sectional, case-control, cohort, and controlled clinical trials. The methodological hierarchy. Debate on observational studies versus controlled clinical trials when evaluating the effectiveness of an intervention.
- Fundamental statistical concepts: Description, inference, univariate and multivariate analysis.
- Practical aspects of protocol management: Sample size calculation, questionnaire and database preparation. Operations manual. Basic characteristics of successful projects.
- Other designs: systematic reviews and meta-analyses, cost-effectiveness analysis.
- Critical review of methodology in published clinical studies.
- Informed Consent: types, methods of obtaining it, basic requirements. Informed Consent as an example of the application of the Principle of Autonomy.
The practical work will consist of the preparation and defense of a research project presented as an “executive summary”.
Chair VI: applied human sciences
Module on Anthropology and Bioethics
It offers new perspectives for understanding humanity, the world, and science, perspectives that are not considered separate from specific professional practice but rather complementary to it. It helps situate medical science within the universality of knowledge. Activities are conducted focusing on reading fundamental texts, critical analysis, and debate.
- The relationship between science, technology, humanity, and ethics is presented as a specific issue of our time. Technoscience is understood as a new relationship between humanity and the world, framed through an ethical and anthropological inquiry. Science, technology, and consciousness: articulation or disjunction?
- An approach to the philosophy and ethics of technology. The phenomenon of technoscience. A dual approach: "engineering" and humanistic. Technocosm and ethocosm as separate territories. The early work of VR Potter. Technology as an anthropological and moral issue.
- Origin and development of technoscience: Scientific paradigm shift: Descartes and Bacon. Science as power. The operational character of modern science. The new anthropological relationship with nature: Heidegger and nature as “Bestand”. Some contemporary voices: J. Ladriêre, von Weiszaker, G. Hottois. The sociological reductionism of scientific knowledge.
- The four orders of knowledge and their respective sciences: Natural knowledge: suprasensible world, sensible world, mathematical world. Logical knowledge. Ethical knowledge. Technical knowledge. Narrowing of the field of human reason: scientism and technocracy.
- The Relationship Between Ethics and Science. The Unity of Practical Reason. Agere: Eudaimonia. Facere: Efficacy. Human Happiness, the End of All Knowledge and Technology. Ethics and Anthropology Today. Contemplation and Utility.
- The human person as a subject of research. Historical background of the issue. Central ethical aspects: - Semantic and epistemological review of the notion of subject of research. - Research within the individual/society framework. - Ethics and the scientific paradigm.
- Legal aspects of medical practice.
Theology Module
From an open perspective, the potential and limitations of human knowledge are analyzed. A brief overview is given of different views on what truth is and how to acquire certainty in various areas of reality.
- Differences between knowing and feeling.
- Science and reason. Scope and perspectives.
- Science and faith: are they friends or enemies?
- Current problems: application to specific cases in daily life.