Antihypertensive Medications

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Questions and Answers

According to the 2017 ACC/AHA guidelines, what blood pressure reading is classified as Elevated?

  • 130-139/80-89 mmHg
  • 120-129/less than 80 mmHg (correct)
  • Less than 120/80 mmHg
  • 140/90 mmHg or higher

In the context of hypertension management, what is the primary reason for recommending lifestyle modifications?

  • To replace the need for drug therapy completely.
  • To quickly achieve blood pressure goals without medication.
  • To complement drug therapy and potentially reduce the required dosage. (correct)
  • To diagnose the underlying cause of hypertension.

What is the general recommendation regarding blood pressure measurement technique to ensure an accurate reading?

  • Take multiple measurements until two consecutive readings are the same.
  • Take two measurements, 5 minutes apart, and average the results.
  • Take three measurements at 1-minute intervals and use the average of the last two. (correct)
  • Take one measurement after 15 minutes of relaxation.

According to the provided information, what is the general blood pressure target for most patients requiring antihypertensive treatment?

<p>Less than 130/80 mmHg (B)</p>
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What is a key consideration when selecting a blood pressure cuff size for accurate measurement?

<p>The cuff should fit the arm size, with the bladder covering 75-100% of the arm circumference for manual auscultatory devices. (D)</p>
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What is the general recommendation for sodium intake as part of a nonpharmacologic intervention to manage hypertension?

<p>Reduce intake to less than 1500 mg/day, aiming for at least a 1000 mg/day reduction. (A)</p>
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Which of the following best describes the mechanism of action of thiazide diuretics in treating hypertension?

<p>Inhibiting sodium-chloride transporter in the distal tubule, leading to increased sodium and chloride excretion. (C)</p>
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What electrolyte imbalances are commonly associated with thiazide diuretic use?

<p>Hypokalemia, Hyponatremia, Hypomagnesemia, and Hypercalcemia (D)</p>
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What condition would be considered a contraindication or require caution when prescribing thiazide diuretics?

<p>Active gout or history of gout (C)</p>
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What is the primary mechanism of action of ACE inhibitors in the management of hypertension?

<p>Inhibiting the action of angiotensin-converting enzyme (ACE), reducing the formation of angiotensin II. (D)</p>
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Which of the following is a common side effect associated with ACE inhibitors, but not typically associated with ARBs?

<p>Dry cough (D)</p>
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What should be monitored within two weeks of initiating or changing the dose of an ACE inhibitor or ARB?

<p>Potassium and serum creatinine (SCr) (A)</p>
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Which of the following conditions is a contraindication for the use of ACE inhibitors and ARBs?

<p>Pregnancy (A)</p>
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How do angiotensin II receptor blockers (ARBs) primarily lower blood pressure?

<p>By blocking angiotensin II receptors on blood vessels and tissues. (C)</p>
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What is the primary mechanism of action of calcium channel blockers (CCBs) in treating hypertension?

<p>Blocking the entry of calcium into vascular smooth muscle, cardiac myocytes, and cardiac nodal tissue. (C)</p>
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What is the key difference between dihydropyridine and non-dihydropyridine calcium channel blockers (CCBs)?

<p>Dihydropyridines are more selective for vascular cells, while non-dihydropyridines have more direct cardiac effects. (B)</p>
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Peripheral edema is a side effect that is most commonly associated with which class of antihypertensive medications?

<p>Dihydropyridine calcium channel blockers (A)</p>
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Why should Non-dihydropyridine calcium channel blockers like diltiazem and verapamil be avoided in patients with heart failure?

<p>They can worsen heart failure symptoms due to their effects on cardiac contractility and heart rate. (C)</p>
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A patient with hypertension also has benign prostatic hyperplasia (BPH). Which class of antihypertensive agents should be used with caution, if at all?

<p>Alpha-1 blockers (B)</p>
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Which of the following best describes the mechanism of action of aldosterone antagonists, such as spironolactone, in treating hypertension?

<p>Blocking the action of aldosterone in the distal tubule, promoting sodium and water excretion while retaining potassium. (D)</p>
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What is a notable side effect often associated with spironolactone but less so with eplerenone?

<p>Gynecomastia (A)</p>
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Which antihypertensive drug class is known to directly inhibit sodium channels in the distal renal tubule?

<p>Potassium-sparing diuretics (D)</p>
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In what clinical scenario are loop diuretics most commonly used in the context of hypertension management?

<p>In patients with symptomatic heart failure for fluid management. (A)</p>
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What is the primary mechanism of action of beta-blockers in the treatment of hypertension?

<p>Binding to beta-adrenergic receptors and inhibiting the effects of catecholamines. (B)</p>
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Why is abrupt cessation of beta-blocker therapy potentially dangerous?

<p>It may precipitate angina, myocardial infarction, or death. (A)</p>
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What potential effect of beta-blockers requires special consideration in patients with diabetes?

<p>Masking symptoms of hypoglycemia (A)</p>
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In which of the following conditions are beta-blockers generally NOT considered first-line antihypertensive agents?

<p>Uncomplicated hypertension (D)</p>
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What is the primary mechanism by which alpha-2 agonists, such as clonidine, reduce blood pressure?

<p>Reducing sympathetic outflow from the central nervous system. (B)</p>
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Which side effect is of particular concern with the use of alpha-2 agonists, especially in elderly patients?

<p>CNS adverse effects like sedation and dizziness (D)</p>
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What is the primary mechanism of action of hydralazine in treating hypertension?

<p>Dilating arterial blood vessels. (A)</p>
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Why is hydralazine often dosed multiple times a day?

<p>Due to its relatively short duration of action. (B)</p>
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A patient is prescribed chlorthalidone for hypertension. Besides blood pressure, what other laboratory parameter should be monitored regularly?

<p>Electrolytes (potassium, sodium, magnesium, calcium) (C)</p>
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A patient taking lisinopril develops a persistent, dry cough. Which of the following medications would be the most appropriate alternative?

<p>Losartan (C)</p>
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Which of the following is a first-line agent in treating hypertension and is preferred for black patients?

<p>CCBs (C)</p>
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According to the information provided, what should be done with beta blockers before surgery?

<p>Continue beta-blocker therapy perioperatively (D)</p>
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A patient has stage 2 hypertension according to ACC/AHA guidelines. What is the general recommendation regarding the initiation of antihypertensive medication?

<p>Initiate two first-line agents from different classes. (A)</p>
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A patient with resistant hypertension is already taking an ACE inhibitor, a thiazide diuretic, and a beta-blocker. Which of the following medications would be the MOST appropriate next addition to their treatment regimen?

<p>Spironolactone (C)</p>
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A patient with hypertension and a history of angioedema while taking an ACE inhibitor. Which of the following medications would be the MOST appropriate antihypertensive to prescribe initially?

<p>Diltiazem (A)</p>
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While counseling a patient being started on chlorthalidone for hypertension, which of the following points is MOST important to emphasize regarding lifestyle modifications?

<p>Adopt a diet rich in fruits, vegetables, and low-fat dairy products (DASH diet). (B)</p>
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A patient who is prescribed chlorthalidone is also taking NSAIDs for chronic pain. What potential interaction should the healthcare provider be aware of?

<p>Reduced antihypertensive effect of chlorthalidone (A)</p>
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For accurate blood pressure readings, which of the following instructions should be given to a patient?

<p>Rest quietly for 3-5 minutes before the measurement. (B)</p>
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Combining an ACE inhibitor with which other medication class could lead to an elevated risk of hyperkalemia?

<p>Potassium-sparing diuretics (B)</p>
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When initiating a patient on lisinopril, which of the following should be monitored within the first two weeks?

<p>Potassium and serum creatinine (C)</p>
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Which of the following is a significant adverse effect more commonly associated with spironolactone compared to eplerenone?

<p>Gynecomastia (A)</p>
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In a patient with hypertension and a history of gout, which diuretic should be used with caution?

<p>Chlorthalidone (B)</p>
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Why is it important to gradually taper beta-blocker therapy rather than abruptly discontinuing it?

<p>To avoid rebound hypertension or angina (A)</p>
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What is the primary reason non-dihydropyridine calcium channel blockers like diltiazem and verapamil should be used cautiously in patients with heart failure?

<p>They can worsen heart failure due to their negative inotropic effects. (A)</p>
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For most patients, what is the recommended blood pressure target according to the ACC/AHA guidelines?

<p>&lt;130/80 mmHg (D)</p>
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A patient with hypertension is also being treated for benign prostatic hyperplasia (BPH). Which class of antihypertensive medications should be used with caution?

<p>Alpha-1 blockers (A)</p>
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Which antihypertensive drug class is known to potentially mask the symptoms of hypoglycemia in patients with diabetes?

<p>Beta-blockers (B)</p>
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Among the thiazide diuretics, which agent is generally preferred due to its longer half-life and evidence to support its use?

<p>Chlorthalidone (D)</p>
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For a patient starting on a thiazide diuretic, what electrolyte imbalances are most important to monitor within the first few weeks?

<p>Potassium and magnesium (D)</p>
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A patient taking an ACE inhibitor develops angioedema. Which of the following antihypertensive medications is contraindicated?

<p>An ARB (C)</p>
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According to the 2017 ACC/AHA hypertension guidelines, at what stage of hypertension should two first-line agents from different classes be considered initially?

<p>Stage 2 hypertension or BP &gt; 20/10 mmHg above goal (C)</p>
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Which class of diuretics acts by directly inhibiting sodium channels in the distal renal tubule?

<p>Potassium-sparing diuretics (D)</p>
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ACE inhibitors block the conversion of Angiotensin I to Angiotensin II. What is the effect of ARBs?

<p>ARBs block Angiotensin II receptors (B)</p>
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Dihydropyridines are more effective at affecting what area of the body?

<p>Vascular Smooth Muscle (D)</p>
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Potassium sparing diuretics are often combined with what medication class?

<p>Thiazide Diuretics (B)</p>
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Alpha-2 agonists act as vasodilators; act in the central nervous system to reduce sympathetic outflow from the CNS. What serious effect can arise from their use?

<p>heart block (A)</p>
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What is a common side effect from Dihydropyridine Calcium Channel Blockers that primarily affects the lower extremities?

<p>Peripheral Edema (B)</p>
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ACE-I have been shown to have decreased effectiveness in preventing heart failure and stroke in what population? (Select the best answer)

<p>Black patients (A)</p>
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Loop diuretics have a higher risk of profound diuresis/dehydration. What is a monitoring parameter in addition to renal function to monitor for this?

<p>Electrolytes (potassium, sodium, magnesium, calcium) (C)</p>
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A 52 year old male with repeat blood pressure of 135/78 mmHg. No prior history of HTN or other medical conditions. No current HTN medications. What stage HTN is this? His calculated ASCVD Risk is 15%. What medication would you start first?

<p>Chlorthalidone (B)</p>
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Flashcards

What is normal blood pressure?

Blood pressure where systolic is less than 120 mmHg and diastolic is less than 80 mmHg.

What is elevated blood pressure?

Blood pressure where systolic is 120-129 mmHg, and diastolic is less than 80 mmHg.

What is Stage 1 Hypertension?

Blood pressure where systolic is 130-139 mmHg or diastolic is 80-89 mmHg.

What is Stage 2 Hypertension?

Blood pressure where systolic is 140 mmHg or higher or diastolic is 90 mmHg or higher.

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What is the DASH diet?

Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced saturated fat.

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How is hypertension diagnosed?

The average of two or more properly measured blood pressure readings taken 1-2 minutes apart, on two or more visits spaced 1-4 weeks apart.

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How do Thiazide diuretics work?

Inhibits the sodium-chloride transporter in the distal tubule to increase sodium and chloride excretion.

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Name common Thiazide diuretics

Chlorthalidone or Hydrochlorothiazide (HCTZ).

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What are Thiazide diuretics side effects?

Low potassium, low sodium, low magnesium, high calcium, high glucose, and high uric acid.

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What to monitor on Thiazide diuretics?

Check blood pressure, electrolytes, renal function, and blood glucose.

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How do ACE inhibitors work?

Blocks the action of angiotensin converting enzyme (ACE) to inhibit the formation of angiotensin II.

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What are the side effects of ACE inhibitors?

Dry cough, high potassium, a transient rise in SCr.

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How do ARBs (Angiotensin II Receptor Blockers) work?

Block Angiotensin II receptors on blood vessels.

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Examples of ARBs.

Valsartan, losartan, and irbesartan.

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What are the side effects of ARBs?

High Potassium, transient rise in SCr. angioedema.

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What to monitor when using ARBs?

Check potassium and SCr within 2 weeks of starting or changing dose and also blood pressure

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When are ARBs contraindicated?

Pregnancy and patients with history of angioedema.

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How do Calcium Channel Blockers (CCBs) work?

Binds to L-type calcium channels on vascular smooth muscle, cardiac myocytes, and cardiac nodal tissue.

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What are Dihydropyridines?

Medications such as amlodipine, nifedipine, and felodipine that are more selective for vascular cells; minimal direct cardiac effects

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Side effects of Dihydropyridines?

Low blood-pressure, dizziness, peripheral edema.

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What are Non-dihydropyridines?

Diltiazem and verapamil which are effective both as antihypertensive as well as anti-arrhythmics (reduce heart rate)

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What are the side effects of Non-dihydropyridines?

Low blood-pressure, dizziness, edema, constipation, and bradycardia.

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What is Beta-blockers?

Beta-blockers is a medication class that blocks the adrenalin receptors, act directly to block the receptor, don't cough

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How do aldosterone antagonists work?

Block the action of aldosterone in kidney's distal tubule.

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What are examples of aldosterone antagonists?

Spironolactone and Eplerenone.

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What are the side effects of aldosterone antagonists?

High potassium and Gynecomastia (spironolactone).

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How do potassium-sparing diuretics work?

Directly inhibit sodium channels in the distal tubule.

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What are the side effects of potassium-sparing diuretics?

high potassium and high uric acid .

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How do loop diuretics work?

Inhibits the sodium-potassium-chloride cotransporter in the thick ascending limb of the loop of Henle.

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What are the side effects of loop diuretics?

Profound diuresis, low magnesium, low potassium, and high uric acid.

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How do beta-blockers work?

Binds to beta-adrenergic receptors.

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What are Beta-blockers side effects?

Bronchospasm, slowed heart rate, dizziness, and fatigue.

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How do alpha-2 agonists work?

Acts on the central nervous system to reduce sympathetic outflow from the brain to decrease peripheral resistance, heart rate and blood-pressure.

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Side effects of alpha-2 agonists?

Dry mouth, dizziness, sedation, and low blood pressure.

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How do vasodilators work?

Highly selective action on arterial vessels to reduce vascular resistance and blood pressure.

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What the side effects of vasodilators?

Low blood pressure, swelling, heart palpitations, headache, and flushing.

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Study Notes

  • Antihypertensive Medications

Lecture Objectives

  • Describe the pharmacology/mechanism of action of antihypertensive medications
  • Identify common and serious side effects of antihypertensive medications
  • List monitoring parameters
  • Discuss selection of medication based on patient's medical history and co-morbidities

Lecture Overview

  • Review hypertension guidelines
  • Pathophysiology of hypertension & pharmacotherapy targets
  • First-line Agents: ACE inhibitors/ARBs, calcium channel blockers, and thiazide diuretics
  • Other Agents: Beta blockers, other diuretics, alpha-2 agonists, and vasodilators
  • Cases

Hypertension presentation

  • Elevated blood pressure is often the only sign
  • The condition is often asymptomatic
  • Signs and symptoms may arise due to cardiovascular, cerebrovascular, retinal, and renal complications of disease
  • Hypertension is known as "The silent killer"
  • First heart attack: 7 out of 10 patients have high blood pressure
  • First stroke: 8 out of 10 patients have high blood pressure
  • Chronic heart failure: 7 out of 10 patients have high blood pressure

Diagnosis and Goals

  • All individuals age 18+ should be screened for hypertension yearly
  • Use the average of two or more properly measured blood pressure readings taken 1-2 minutes apart
  • Blood pressure must be elevated when measured at two or more visits spaced 1-4 weeks apart
  • The exception is made for individuals with HTN emergency (≥180/120mmHg) or ≥160/100mmHg with known end-organ damage
  • Blood pressure lowering with antihypertensive therapy is associated with 35-40% reduction in stroke, 20-25% reduction in myocardial infarction and >50% reduction in heart failure

Blood Pressure Monitoring Technique

  • Follow these steps to ensure an accurate reading
  • The room should be Quiet and a comfortable temperature
  • No smoking, coffee, or exercise for 30 minutes
  • Empty bladder
  • Relax for 3-5 minutes
  • Taking 3 measurments at 1 minute intervals then use the average of the last 2 measurements

Blood Pressure Cuff Size

  • 22-26cm arm circumference. recommended small adult cuff size
  • 27-34cm arm circumference, recommended standard adult cuff size
  • 35-44cm arm circumference, recommended large adult cuff size
  • Greater than 45cm arm circumference, thigh size

Goals of Treatment

  • The 2017 ACC/AHA Guidelines from the American College of Cardiology and American Heart Association should be followed
  • Includes ASCVD risk scoring
  • Includes direction on screening for masked or white coat hypertension

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