Hypertension Canada Guidelines

Question 1

How do you take an AOBP (Automated office BP)?

Answer 1

• 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.

• A recently calibrated aneroid device or sphygmomanometer should be used. Ensure the device is clearly visible at eye level.
• A cuff with an appropriate bladder size for the size of the arm should be chosen: bladder width should be close to 40% of the arm circumference and length should cover 80-100% of the arm circumference.
• The arm should be bare, supported, and kept at heart level.
• The lower edge of the cuff should sit 3 cm above the elbow crease with the bladder centred over the brachial artery.

• The patient should rest comfortably for
5 minutes prior to the measurement in the seated position with their back supported.

• The patient’s legs should be uncrossed with feet flat on the floor.
• There should be no talking and the room should be quiet.
• The first reading should be discarded and the latter two averaged.

Question 2

Threshold for diagnosis in DM?

Answer 2

A mean SBP ≥130 mmHg and/or DBP ≥80 mmHg.

Question 3

Threshold for diagnosis using an AOBP (automated office BP)? Patient is not high risk and does not have DM.

Answer 3

A mean SBP ≥135 mmHg or DBP ≥85 mmHg taken over 3-5 visits OR ≥ 180/110 on first visit.

Question 4

Home blood pressure (home BP) monitoring can be used in the diagnosis of hypertension, and monitoring on regular basis should be considered for hypertensive patients with:

Answer 4

• Diabetes mellitus
• Chronic kidney disease
• Suspected non-adherence
• Demonstrated or suspected white coat
• BP controlled in the office but not at home (masked hypertension)

Question 5

Home BP threshold for diagnosis:

Answer 5

SBP >135 mmHg or

DBP >85 mmHg

Question 6

How do you take a Home BP series for HTN diagnosis?

Answer 6

White coat or sustained hypertension values should be based on duplicate measures, morning and evening for seven days. First day values should be discarded.

Question 7

Non-AOBP (auscultated) threshold for diagnosis:

Answer 7

A mean SBP ≥140 mmHg and/ or DBP ≥90 mmHg.

Question 8

What percentage of patients on medications for HTN develop diabetes each year? What are some additional risk factors?

Answer 8

Diabetes develops in 1-3% per year of those with drug-treated hypertension.

Additional risk factors: treated with a diuretic or β-Blockers, impaired fasting glucose or impaired glucose tolerance, obesity (especially abdominal), dyslipidemia, sedentary lifestyle and poor dietary habits.

Question 9

How often should patient with HTN be screen for DM and with what test?

Answer 9

Annually (FBG)

Question 10

Preliminary lab work/investigations? (5)

Answer 10

1. Urinalysis
2. K+ NA+ Cr
3. FBG or HmgA1C
4. Lipids
5. Standard 12-lead ECG

Question 11

Presence of TOD makes patient moderate-high to high risk. What are the four categories of Target Organ Damage (TOD)?

Answer 11

Cardiovascular disease
• Coronary Artery Disease
• Acute coronary syndromes
• Angina pectoris
• Myocardial infarction
• Heart Failure
• Left Ventricular Dysfunction
• Left Ventricular Hypertrophy

Cerebrovascular Disease
• Aneurysmal sub-arachnoid hemorrhage
• Dementia
• Intracerebral hemorrhage
• Ischemic stroke or transient ischemic attack
• Vascular dementia
• Mixed vascular dementia and Alzheimer’s

Hypertensive Retinopathy Peripheral Arterial Disease
• Intermittent claudication

Renal Disease
• Albuminuria
• Chronic Kidney Disease (GFR < 60 ml/min/1.73 m2)

Question 12

HTN High Risk patient (4):

Answer 12

Clinical or sub-clinical cardiovascular disease

Chronic kidney disease (non-diabetic nephropathy, proteinuria <1g/d, *estimated glomerular filtration rate
20-59 mL/min/1.73m2)

Estimated 10-year global cardiovascular risk ≥15%

Age ≥75 years

Question 13

Threshold for treatment (with drugs) and targets for:

1) High risk
2) DM
3) Moderate-high risk
4) Low risk

Answer 13

1)High risk
Threshold: ≥ 130 (DBP N/A)
Target: < 120 (DBP N/A)

2)DM
Threshold: ≥ 130/ ≥ 80
Target: < 130/ < 80

3) Mod risk
Threshold: ≥ 140/ ≥ 90
Target: < 140/ <90

4)Low risk
Threshold: ≥ 160/≥ 100
Target: < 140/ <90

Question 14

Health Behaviour Recommendations (WEADSS)

Answer 14

Weight (BMI 18.5-24.9) and waist (<88 female/<102 male)
Exercise: 30-60 min/day 4-7 days per week
Alchohol: < 14/wk male / < 9/wk female
Diet: Low-dairy/DASH/high potassium
Smoking: Ask/Assist/Assess/Advise/Arrange
Stress: CBT

Question 15

Secondary HTN causes:

Answer 15

• Renal insufficiency
• Renovascular disease
• Primary hyperaldosteronism
• Thyroid disease
• Pheochromocytoma and other rare endocrine causes
• Obstructive sleep apnea