Hypertension- Diagnosis

Question 1

People with white coat have an overall CV risk similar to _

Answer 1

those with normotension

Question 2

In people with DM when is a dx HTN probable?

Answer 2

When office readings are 130+/80+ for 3 or more times on different days

can still consider out of office measurements to r/o white coat

Question 3

There is no agreed on #, but for people with DM the treshold for ABPM and HBPM to dx HTN is likely_

Answer 3

lower than the general population

Question 4

In diabetics doing ABPM the absence of nocturnal dipping of BP is common and correlates to _

Answer 4

higher CV mortality

Question 5

In diabetics doing ABPM, the basline 24 hour SBP and night time SBP are independent predictors of _

Answer 5

short term CV outcomes

Question 6

At initial presentation patients who exhibit features of hypertensive urgency or emergency requires _ and _

Answer 6

immediate diagnosis and management

Question 7

What are examples of hypertensive urgency or emergency?

5

Answer 7

Asymptomatic** diastolic** BP ≥130 mmHg

Severe elevation of BP in the setting of any of:

• Acute coronary syndrome
• Acute kidney injury
• Pre-eclampsia/eclampsia
• Catecholamine-associated hypertension

Question 8

In patients at initial visit with elevated BP without heatures of hypertensive urgency or emergency what should the next step be?

Answer 8

take at least 2 more readings during same visit

Question 9

If visit 1 OBPM is high-normal when should BP be next assessed?

Answer 9

at yearly intervals

high normal 130-139/85-89

Question 10

If visit 1 AOBP or OBPM is high what is the next step?

AOBP high 135+/85+
OBPM 140+/90+

2

Answer 10

• H&P
• if needed diagnostics for target organ damage/CV risk factors within 2 visits

Question 11

If visit 1 AOBP or OBPM is high when should visit 2 be scheduled?

Answer 11

within 1 month

Question 12

What are exogenous factors that can induce or aggravate HTN?

2

Answer 12

Prescription drugs and other substances

Question 13

What prescription drugs can induce or worsen HTN

8

Answer 13

• NSAIDs
• Steroids
• OCPs and hormones
• Decongestants
• Calcineurin inhibitors (cyclosporin, tacrolimus)
• Erythropoietin
• Antidepressants
• Midodrine

Question 14

How do NSAIDs increase BP?

Answer 14

increase prostaglandins (which cause renal artery dilation), therefore less dilation = less blood flow to kidneys

Question 15

What 4 other substances can induce or worsen HTN

Answer 15

licorice root
stimulants like cocaine
salt
excessive alcohol

Question 16

FYI

Examples of target organ damage to check for when AOBP and OBPM is high at visit 1

should be arranged within 2 visits

Answer 16

• Cerebrovascular disease
• Stroke
•  Dementia
• Hypertensive retinopathy
• Left ventricular dysfunction
• Left ventricular hypertrophy
• Heart failure
• Coronary artery disease
•  Myocardial infarction
•  Angina pectoris
•  Acute coronary syndromes
• Renal disease
•  Chronic kidney disease (GFR < 60 mL/min/1.73 m2)
•  Albuminuria
• Peripheral artery disease
•  Intermittent claudication

Question 17

What does a history of clinically overt atherosclerotic disease indicate?

Answer 17

very high risk for a recurrent atherosclerotic event

(eg, peripheral arterial disease, previous stroke or transient ischemic attack)

Question 18

In what case at visit 1 can HTN be immediately dx’d

Answer 18

BP 180+/110+

Question 19

If visit 1 AOBP high or OBPM high (but not 180/110) what should be done before next visit?

Answer 19

out of office BP measurements

Question 20

If ABPM is done what readings confirm HTN

Answer 20

mean awake 135+/85+
mean 24 hour 130+/80+

Question 21

When can HBPM be used to dx HTN

3

Answer 21

ABPM not tolerated
ABPM not available
pt preference

Question 22

What readings of HBPM qualify as HTN

Answer 22

mean 135+/85+

Question 23

If a patient at visit 1 had elevated BP but out of office readings are normal what is next step?

answer for if HBPM was used and if ABPM was used

Answer 23

HBPM- confirm with ABPM or with repeat HBPM

ABPM - dx white coat HTN

Question 24

What treatment is needed for white coat HTN

Answer 24

none

Question 25

In patients with clinical and or lab features of HTN what should be done?

Answer 25

investigations for secondary causes of HTN