Hypertension diagnosis

Question 1

Modifiable risk factors for HTN

Answer 1

MODIFIABLE

• smoking
• ETOH
• sedentary
• poor diet (high sodium, low veg/fruit)
• body comp (high wt/BMI/WC)

Question 2

Non-modifiable risk factors for HTN

Answer 2

NON-MODIFIABLE

• age
• family hx
• ethnicity (African, South Asian)

Question 3

Rx medications that increase risk for HTN

Answer 3

• NSAIDs
• steroids
• decongestants
• oral contraceptives
• ETOH
• stimulants

Question 4

Factors that may contribute to secondary HTN

Answer 4

• meds (NSAIDs, steroids, OCP)
• primary kidney disease
• primary aldosteronism
• Cushing’s
• renovascular HTN
• OSA
• thyroid disease
• coarctation of aorta

Question 5

What are situations where you would consider secondary cause of HTN?

Answer 5

• severe/refractory HTN
• acute rise when previously stable
• age <30 without fam hx
• no nocturnal fall in BP during 24 hour ABPM

Question 6

When should you check blood pressure in adults?

Optimal conditions for checking BP:

• no smoking/caffeine for ____ min
• sitting quietly for minimum _____ min
• sitting position:
• legs and feet:
• lower cuff _____ above elbow crease
• intervals: Q _____ min
• measure in _____ arm

Answer 6

-all adults at all appropriate visits

• no smoking/caffeine x 30 min
• sit quietly x 5 min
• sit with back support
• legs uncrossed, feet flat
• lower cuff 3 cm above elbow crease
• q1-2 min
• measure BOTH arms

Question 7

Components of physical exam for visit for HTN (besides checking BP):

Answer 7

MEASURE: wt, ht, WC
EYES: fundoscopy
CVS + PVS
Abdo

Question 8

Hypertension Canada HIGH RISK patient is defined as:

```
-age:
AND
-SBP:
AND
-1 or more CV risk factors
name all 4
~~~

Answer 8

High risk:

age: 50+
SBP: 130-180

CV risk factors:

• CVD
• CKD
• CV 10 year risk 15% and more
• age 75+

Question 9

Hypertension Canada HIGH RISK patient

Risk factor of chronic kidney disease is defined as:

• non-diabetic:
• proteinuria:
• eGFR:

Answer 9

• non-diabetic nephropathy
• proteinuria <1 g/day
• eGFR 20-59

Question 10

Hypertensive emergency is defined as:

Answer 10

HTN Canada: >180/120

BC Guidelines:
DBP >130, BP>180/110

Question 11

AOBP stands for:

How is it taken?

Threshold for HTN:

Answer 11

Automated office BP

• NO provider present
• patient unattended in print area
• 3-6 consecutive readings 1-2 min apart

Threshold:
3+ measurements on different days
SBP ≥135
DBP≥85

*If office BP
>180/110
Dx on first visit!

Question 12

OBPM stands for:

How is it taken?

Threshold for HTN:

Threshold with DM:

Answer 12

office BP measurement
*automated (preferred) or manual

• provider is in the room
• take 3 readings, discard first

Threshold for HTN:
*3+ measurements on different days
SBP ≥ 140
DBP ≥ 90

*If office BP
>180/110
Dx on first visit!

Threshold with DM:
SBP ≥ 130
DBP ≥ 80

Question 13

ABPM stands for:

How is it taken?

Threshold for HTN:

Answer 13

Ambulatory BP monitoring

• wearing BP x 24 hours
• measures q20-30 min
• preferred out of office method of dx

Threshold for HTN:
24-hour or daytime
SBP ≥130
DBP≥80

Question 14

HBPM stands for:

How is it taken?

Threshold for HTN:

Answer 14

home BP monitoring

• check twice in morning and evening x 7 days (28 readings total)
• discard first day, average remainder

Threshold for HTN:
SBP ≥135
DBP ≥85

Question 15

What diagnostic tests would you order with diagnosis of HTN?

Labs:
Calculate:
Other:

Answer 15

CBC, lytes, BUN/Cr, TSH
lipids, fasting gluc/A1C
Urine ACR, u/a for hematuria
*HTN Canada says ACR in absence of DM or renal disease not supported by current evidence
*TSH not included in HTN Canada guidelines

CV risk assessment

ECG