Summary : This figure presents a concept map outlining the management strategies and workup for pulmonary hypertension (PH) in patients with chronic kidney disease (CKD) being considered for kidney transplantation (KTx). It details evaluation algorithms, general PH care, and targeted therapies, organized by WHO PH group classification. flowchart: # Nodes : • Management Strategies for KTx Candidates with PH (central rectangle) • Group 1 PH (rectangle) – Consider Vasodilator Testing during RHC to direct targeted therapies – Individualize treatment based on PH severity, administration route, patient preferences, side effects, clinical experience – Caution: slow titration and care by experienced practitioner – Anticoagulation for Idiopathic PAH only – Targeted Therapies: • CCBs (criteria for use listed) • ERAs: Bosentan, Ambrisentan, Macitentan • Prostacyclins: Epoprostenol (IV), Treprostinil (SQ, IV, PO), Iloprost (inhaled) • NO Pathway Agents: PDE-5 inhibitors (Sildenafil, Tadalafil), Soluble guanylate cyclase stimulators (Riociguat) • Evaluation Algorithm (Fig 2) including determination of need for RHC for WHO Group classification (rectangle) • General PH Care (rectangle) – Disease state education – Low-level aerobic exercise, consider pulmonary rehab – Avoid heavy physical exertion – Oxygen if hypoxia present – Low sodium diet (<1500 mg/day) in RV failure – Routine immunizations (influenza, pneumococcal) – Consider referral to specialized PH clinic – Consider PH clinical trial referral • Group 2 PH (rectangle) – Left Heart Dysfunction: Manage per ACC/AHA Guidelines – Volume Overload: Target increased ultrafiltration with dialysis (lower “Dry WT”) • Group 3 PH (rectangle) – Manage underlying pulmonary/respiratory conditions (e.g., CPAP for OSA) • Group 4 PH (rectangle) – Anticoagulation (caution: bleeding risks) – Thrombectomy (caution: surgical risks) • Group 5 PH (rectangle) – Volume Overload: Target increased ultrafiltration with dialysis (lower “Dry WT”) – Uremia/Under-dialysis: Optimize dialysis prescription – Anemia, Metabolic Disorders: Manage anemia/metabolic status per KDOQI guidelines – High Flow from AVF: Consider AVF ligation (Fig 2) # Connectors : • Central node “Management Strategies for KTx Candidates with PH” branches to: – Group 1 PH – Evaluation Algorithm (Fig 2) – General PH Care – Group 2 PH – Group 3 PH – Group 4 PH – Group 5 PH • Group 1 PH node contains sub-branches for Vasodilator Testing, Individualized Treatment, Anticoagulation, and Targeted Therapies. • Targeted Therapies node further branches to CCBs, ERAs, Prostacyclins, NO Pathway Agents. • Group 5 PH node contains sub-branches for Volume Overload, Uremia/Under-dialysis, Anemia/Metabolic Disorders, High Flow from AVF. # Layout : • Central node at top center, with six main branches radiating outward for each PH group and general care. • Sub-nodes and therapy options are nested under their respective group nodes. • Flow is hierarchical, with decision points and therapy options clearly separated by group classification. # Analysis : • The figure provides a comprehensive, group-based approach to PH management in CKD patients considered for KTx. • Group 1 PH receives the most detailed targeted therapy options, including vasodilator testing and multiple drug classes. • General PH care recommendations apply across all groups, emphasizing education, exercise, diet, and immunization. • Volume overload and dialysis optimization are highlighted for Groups 2 and 5, reflecting CKD-specific concerns. • Anticoagulation and thrombectomy are reserved for Group 4 PH, with cautions noted. • The map visually organizes complex decision-making, ensuring tailored management based on PH group and CKD context.

Summary : This flowchart presents an algorithm for the management of new-onset post-partum hypertension, outlining the diagnostic and decision-making process based on the presence or absence of organ dysfunction and associated symptoms or laboratory findings. flowchart: # Nodes : • Start (rounded rectangle): "New-onset post-partum hypertension (BP ≥140/90 mmHg)" • Decision (rounded rectangle): "Hypertension only without signs of organ dysfunction" • Decision (rounded rectangle): "Hypertension plus signs of organ dysfunction" • Process (circle): "Post-partum hypertension" • Process (rounded rectangle): "Proteinuria" • Process (rounded rectangle): "Neurological symptoms" • Process (rounded rectangle): "Serum laboratory abnormalities" • Process (rounded rectangle): "Severe persistent right upper quadrant or epigastric pain" • Process (rounded rectangle): "Evaluate for" – "Cerebral venous thrombosis/stroke" – "Acute fatty liver of pregnancy, Thrombocytopenia, impaired liver function, renal insufficiency" • Process (rounded rectangle): "Other aetiologies excluded" • End (circle): "Post-partum pre-eclampsia/eclampsia" # Connectors : • The initial node splits into two branches: – Left: "Hypertension only without signs of organ dysfunction" → "Post-partum hypertension" – Right: "Hypertension plus signs of organ dysfunction" → three parallel branches: ◦ "Proteinuria" → "Severe persistent right upper quadrant or epigastric pain" ◦ "Neurological symptoms" → "Evaluate for cerebral venous thrombosis/stroke" ◦ "Serum laboratory abnormalities" → "Evaluate for acute fatty liver of pregnancy, Thrombocytopenia, impaired liver function, renal insufficiency" • All three right-side branches converge at "Other aetiologies excluded" → "Post-partum pre-eclampsia/eclampsia" # Layout : • Top-down hierarchical structure. • Initial decision splits into two main branches (left: without organ dysfunction, right: with organ dysfunction). • Right branch further splits into three parallel symptom/lab findings, each with its own evaluation step, then reconverges. # Analysis : • The flowchart distinguishes between simple post-partum hypertension and more severe cases with organ dysfunction. • Presence of proteinuria, neurological symptoms, or laboratory abnormalities prompts further evaluation for specific complications. • If other causes are excluded, a diagnosis of post-partum pre-eclampsia/eclampsia is made. • The algorithm provides a clear, stepwise approach to guide clinicians in the assessment and management of post-partum hypertension.

Summary : This figure presents a pyramid-based treatment algorithm for managing diabetes in patients with chronic kidney disease (CKD), highlighting a stepwise approach from lifestyle interventions to advanced pharmacological therapies, with regular risk factor reassessment every 3–6 months. pyramid diagram: # Overall Structure : • The diagram is a pyramid divided into horizontal layers, each representing a different level of intervention for diabetes with CKD. • The left side of the pyramid shows the progression from lifestyle/self-management at the base to additional risk factor control at the apex. • The right side labels the layers as "Lifestyle and self-management," "First-line drug therapy," "Additional drugs with heart and kidney protection," and "Additional risk factor control." • A yellow circle at the top right states: "Regular risk factor reassessment (every 3–6 months)." # Lifestyle and Self-Management (Base Layer) : • Diet (depicted with fruits and vegetables) • Exercise (person running) • Smoking cessation (cigarette with a red cross) • Weight (scale) # First-Line Drug Therapy (Second Layer) : • Metformin (T2D) (white pills) • SGLT2 inhibitor (T2D) (yellow pills) • RAS blockade (HTN) (red pills) • Statin (orange pills) # Additional Drugs with Heart and Kidney Protection (Third Layer) : • GLP-1 RA (T2D) (injector pen) • Antiplatelet therapies (ASCVD) (blue pills) • ns-MRA (T2D) (beige pills) # Additional Risk Factor Control (Fourth Layer) : • Glycemic control (insulin syringe and glucose meter) • Blood pressure control (blood pressure cuff) • Lipid management (test tubes) # Design Encodings : • Each intervention is represented with a relevant icon (food, exercise, pills, medical devices). • The pyramid structure visually prioritizes foundational lifestyle changes, followed by pharmacological interventions. • Acronyms: T2D (Type 2 Diabetes), HTN (Hypertension), ASCVD (Atherosclerotic Cardiovascular Disease), ns-MRA (non-steroidal Mineralocorticoid Receptor Antagonist), GLP-1 RA (Glucagon-like Peptide-1 Receptor Agonist). # Analysis : • The pyramid visually emphasizes the importance of lifestyle and self-management as the foundation for diabetes and CKD care. • Pharmacological therapies are layered above lifestyle interventions, with first-line drugs followed by additional agents for heart and kidney protection. • The apex focuses on controlling additional risk factors, suggesting a comprehensive, multi-modal approach. • The regular risk factor reassessment (every 3–6 months) highlights the need for ongoing monitoring and adjustment of therapy. • The structure suggests a stepwise escalation of care, starting with lifestyle, then adding medications as needed for optimal management.

Summary : This flowchart presents the ASCVD (Atherosclerotic Cardiovascular Disease) risk reduction algorithm for hypertension management, outlining stepwise goals, interventions, and medication options. flowchart: # Nodes : • GOAL: <130 SYSTOLIC/<80 DIASTOLIC mmHg (rectangle, blue) • LIFESTYLE INTERVENTION: Decrease Sodium Intake | Diet (DASH, Mediterranean) | Physical Activity | Achieve Optimal Weight (rectangle, blue) • ARB OR ACE: For initial blood pressure >150/100 mmHg, consider starting DUAL THERAPY combined with another agent below (rectangle, purple) • TITRATE MEDICATION DOSE OR ADD ON THERAPY EVERY 2-3 MONTHS TO REACH GOAL (rectangle, orange) • THIAZIDE | CALCIUM CHANNEL BLOCKER (rectangle, blue) • COMBINED α-β BLOCKER | β1 SELECTIVE BLOCKER | MINERALOCORTICOID RA (rectangle, orange) • ADDITIONAL ANTIHYPERTENSIVE AGENTS: CENTRAL α2 AGONIST | PERIPHERAL α1-BLOCKER | HYDRALAZINE (rectangle, red) # Connectors : • Top-down linear flow from goal setting, lifestyle intervention, initial medication choice, titration, and escalation to additional agents. • ARB/ACE node includes a branch for dual therapy if initial BP is >150/100 mmHg. • Medication escalation proceeds in order: thiazide/calcium channel blocker → combined blockers/mineralocorticoid RA → additional antihypertensive agents. # Layout : • Vertically stacked rectangles, each representing a step in the algorithm. • Colour-coded sections: blue for goals/lifestyle/first-line agents, purple for ARB/ACE, orange for titration/combination, red for additional agents. • Footnotes and references are included at the bottom for clinical context and special considerations. # Analysis : • The algorithm emphasizes a stepwise approach: starting with lifestyle changes, then progressing to medication based on blood pressure severity and response. • Dual therapy is recommended for very high initial BP (>150/100 mmHg). • Medication titration and escalation are structured, with clear options for combination and additional agents. • Colour coding visually separates intervention types and escalation steps. • The flowchart provides a comprehensive, guideline-based pathway for hypertension management in ASCVD risk reduction.