Cardiac (HTN & Dysplipidemia) - MIDTERM Flashcards
How is the SPIN and SNOUT acronym work for sensitivity/specificity?
Sensitive test when Negative rules OUT the disease’,
SPIN for, ‘Specific test when Positive rules IN the disease
For someone with diabetes, what in office BP measurements would indicate a diagnosis of HTN?
Diagnosis is recommended by OBPM ≥ 130/80 mmHg for > 3 measurements on different days. On the guideline this indicates PROBABLE HTN and you should get them to complete out-of-office BP monitoring to rule out whitecoat HTN.
evidence for defining AOBP and out-of-office (ABPM and HBPM) diagnostic thresholds is lacking (so just use same parameters as for those with nondiabetes)
A mean office BP of what value leads to automatic diagnosis with HTN?
> 180/110 (or hypertensive emergency)
For a patient without diabetes, what values of AOBP or OBPM will lead you to take out-of-office BP measurements?
AOBP (preferred) ≥ 135/85
Or OBPM ≥140/90 (if AOBP not available)
What ABPM and HBPM Series mean values lead to diagnosis of HTN?
ABPM (preferred)
Daytime mean ≥ 135/85
24 hour mean ≥130/80
HBPM Series mean ≥ 135/85
Your patient comes to your clinic and their OBPM is 145/98. What do you do next?
Assessment: History
Physical examination
Diagnostic tests for target organ damage (if clinically indicated)
CV Risk factors
Get them to complete out of office (either ambulatory BP monitoring or home BP series)
If these are elevated, can then diagnose with HTN
ABPM
Ambulatory Blood Pressure Monitoring requires the use of
a validated oscillometric device which must be worn by the
patient for a 24-hour period, with measurements taken at 20-
to 30-minute intervals
What occurs in an AOBP
Automated Office Blood Pressure is performed using an
automated device that can take a series of oscillometric
measurements without the provider or others present.
The patient is left unattended in a private area while
3-6 oscillometric, consecutive readings are taken.
(Preferred method for in office BPs)
If AOBP ≥ 135/85, send for out of office measurements
HBPM
Two readings taken each morning and evening
for 7 days (28 total). Discard first day readings and average the
last 6 days.
Do we need to take a BP on both arms?
BP should be taken in both arms on at
least one visit and if one arm has a consistently higher pressure, that
arm should be used for BP measurement and interpretation
OBPM. How many do you take? Which do you average?
Do at least 3 readings. The first reading should be discarded and the rest averaged
if OBPM≥140/90, send for out of office measurements
If you don’t have an at out of office BP monitoring option, what do you do?
Serial office measurements over 3-5 visits can be used if ABPM
or HBPM are not available
You diagnose your patient with HTN. What preliminary tests will you order?
1.Urinalysis
2. Blood chemistry (potassium, sodium and creatinine)
3. Fasting blood glucose and/or glycated hemoglobin (A1c)
4. Serum total cholesterol, low-density lipoprotein (LDL), high-density
lipoprotein (HDL), non-HDL cholesterol, and triglycerides; lipids may
be drawn fasting or non-fasting
5. Standard 12-lead ECG
Routine testing of microalbuminuria in patients with hypertension without
diabetes or renal disease is not supported by current evidence.
Your patient is a 32 year old cis female. You diagnose her with HTN. What is a super duper important thing you need to rule out before initiating healthy behavior changes or antihypertensives?
Preggo!
What is the BP goal for a person with diabetes?
130/80
Hypertension Canada stratifies patients by cardiovascular risk and, based
on that risk, there are different thresholds and targets for treatment.
What is the target BP for someone considered HIGH risk?
SBP <120
(this is on page 14 of the HTN Canada quick reference guide and seems weird to me, especially given that one of the high risk indicators is >75yrs old (and that seems like a low BP target to me for someone that old?)
BP target for low and moderate risk individuals (moderate = TOD or CV risk factors)
<140/90
Exercise recommendation for lowering BP according to HTN canada?
An accumulation of 30-60 minutes of dynamic
exercise of moderate intensity (such as walking,
cycling, swimming) 4-7 days per week in addition
to the routine activities of daily living. Higher
intensities of exercise are no more effective at
BP lowering.
(recommended to both hypertensive and normotensive individuals)
What measurements of weight are recommended for person to help reduce BP?
A healthy BMI (18.5 – 24.9 kg/m²)
waist circumference (<102 cm for men and <88 cm for
women) is recommended for non-hypertensive
individuals to prevent hypertension and for
hypertensive patients to reduce BP
Recommended EtOH intake for person with HTN?
None! But if you must…
Patients with hypertension should abstain from, or
limit alcohol consumption to <2 drinks per day to
lower blood pressure.
