Notes on assessing a pt with HTN

Question 1

Just an elevated blood pressure=maybe you were just exercise or just nervous

Question 2

Is it hypertension or high blood pressure

Secondary is something else is causing it if you remove whats causing it you fix the problem

Has the pt’s hypertension cause damage to the body

Question 3

What’s a perfect blood pressure? <120/80 (less than 120 and less than 80)

Question 4

If pt’s systolic blood pressure is 140 but there diastolic is 72 then there in stage 2 hypertension because there systolic is high so you go whichever one is higher…you don’t get to say I have normal diastolic so I’m normal right no you can’t say that

Question 5

You don’t just take 1 blood pressure and diagnosis someone has having hypertension it should be 2 separate occasions so if you come in and you have never seen them before and there blood pressure is high you can’t be like oh you got hypertension you have the pt come back…there are exceptions to this if you have a pt come in and there blood pressure is 180 over 110 I’m going to start medication technically its recommended anything in the 160 or 100s of diastolic you would start medication…it generally requires more than 1 blood pressure reading to get diagnosis

Question 6

If you have a pt that only had 1 blood pressure and you do not have a diagnosis of hypertension then you need another blood pressure reading…what you will have someones pt already has a diagnosis of hypertension and they don’t have anymore meds they come to u and their blood pressure is high …they already have the diagnosis and your not there to diagnosis that’s different so in that case you can treat they already have the diagnosis

Question 7

But if pt never had the diagnosis of hypertension and they are brand new to you…one blood pressure you need another one and you can’t just take it again 5 minutes later it needs to be on a different day

Question 8

Factors affecting blood pressure as you get older it tends to go up that’s why we use to call it essential hypertension

Question 9

Different times of day blood pressure tends to change…goes down when your sleeping

Question 10

Weight,exercise, different meds, stress,hydration and how well you sleep effect blood pressure

Question 11

The less you sleep the higher the blood pressure

Question 12

Whitecoat hypertension its high when pt is in the office

Question 13

Whitecoat hypertension=pt who is not on any medication and who has high blood pressure associated w/healthcare facilities and good blood pressure at home…the best to do w/those pts is have them check their blood pressure at home but you can also do a ambulatory blood pressure monitor and this gets blood pressure every 15 to 30 minutes during the day and every 30 to 60 minutes at night when they are sleeping so they wear it on their arm and you would not put it over their clothes you would wear it and it would inflate and it would collect the readings

Question 14

Blood pressure should be lower at night when your sleeping it should be <110/65

Question 15

Home blood pressure monitoring pts usually aren’t just their blood pressure correctly at home

Question 16

If you use a cuff that is too small what is that going to do to the blood pressure? Even for pts that don’t have white coat hypertension or something like that there can be a real difference between home numbers and office numbers

Question 17

As a pt is checking their blood pressure at home if they are saying I’m getting blood pressures of 145 over 90 at home and in the office your getting 160 over 100 those line up pretty well so its not a linear relationship btwn home numbers and office numbers if your just doing a manual blood pressure

Question 18

Chart shows its pretty inaccurate with office blood pressure numbers versus home numbers

Question 19

The 24 hour blood pressure monitor is accurate compared to home numbers

Question 20

If you happen to ever be in a office where they do the one where they do 3 and they leave the room that’s what I do in my office…I put the blood pressure monitor on my patients and I set it and it does 3 blood pressures and I leave the room once they are doing it and its meant to mimic home numbers and that’s been shown to be much more like the 24 hours blood pressure monitor and it is equal to those home numbers…it doesn’t diverge as you get into those higher numbers because office numbers tend to be pretty inaccurate and especially when we use the stethoscope which can lead to a lot of issues with over treatment medication issues

Question 21

For pts under 50 years old diastolic pressure is one that is higher and as you get over 50 years old systolic blood pressure is the issue