Chapter 25: Diagnosis and Treatment of Hypertension
Which of the following statements about hypertension is false?
A. Hypertension is a public health problem worldwide
B. Treating hypertension with antihypertensive drugs is effective for the long-term prevention of cardiovascular disease
C. Normal (optimal) pressure is classified as blood pressure < 120/80 mm Hg
D. Blood pressure measurements outside the office or clinic are always identical to office or clinic pressure measurement
E. The prevalence of hypertension is increasing in relation to increased overweight
The answer is D. (Hurst’s The Heart, 14th Edition, Chap. 25) By current guidelines, normal (optimal) pressure is classified as blood pressure < 120/80 mm Hg (option C). Hypertension is highly prevalent in adult populations throughout the world and is increasing in relation to increased overweight and reduced daily exercise (option E), and it is a growning cause of fatal and nonfatal cardiovascular and renal disease worldwide (option A).1,2 The benefits of treating hypertension have been firmly established.3,4
The introduction of 24-hour ambulatory blood pressure monitoring and systematic home blood pressure monitoring has brought to light the fact that blood pressure measured outside the office or clinic may differ substantially from office or clinic pressure (option D). The importance of out-of-office blood pressures for accurate prognosis is now supported by several national and international guidelines.5-8
During a routine checkup, a 55-year-old male factory worker’s recorded blood pressure is 150/90 mm Hg. What is the goal for the initial evaluation of hypertensive patients?
A. Estimate the average blood pressure
B. Consider the overall cardiovascular risk status
C. Determine the presence or absence of target organ pathology
D. Educate the patient on long-term cardiovascular risk reduction
The answer is E. (Hurst’s The Heart, 14th Edition, Chap. 25) Most hypertensive patients are initially identified during office or clinic visits when seen for checkups or nonemergent symptoms. Initial evaluation and classification of these patients is crucial because hypertension is mostly a silent disorder, and patients are often asymptomatic for long periods of time. The goals for the initial evaluation of hypertensive patients include: estimating the average blood pressure (option A), considering the overall cardiovascular risk status (option B), determining the presence or absence of target organ pathology (option C), and beginning the process of education that will lead the patient to recognize and collaborate in long-term risk reduction (option D). It is also an opportune moment to assess the patient for identifiable (secondary) hypertension. Therefore, all of the above are correct (option E).
Which of the following is considered correct blood pressure measurement in the clinic?