Questions and Answers
What is the minimum time interval required between two consecutive blood pressure measurements during home monitoring?
For how many days should blood pressure recordings ideally be performed during home monitoring?
Which of the following does NOT warrant treatment for stage 1 hypertension in individuals under 80 years of age?
What is the blood pressure threshold for diagnosing stage 2 hypertension?
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What was the 2019 recommendation regarding antihypertensive drug treatment for adults under 60 with stage 1 hypertension and a 10-year risk below 10%?
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What should be done if the blood pressure difference between arms exceeds 20 mmHg after repeating measurements?
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Which condition is NOT associated with unequal blood pressure readings between arms?
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If a patient's blood pressure reading exceeds 180/120 mmHg, what are the indications for immediate admission for specialist assessment?
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What is the purpose of using ambulatory blood pressure monitoring (ABPM)?
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What is the recommended action if the first blood pressure reading in a clinical setting exceeds 140/90 mmHg?
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Which of the following conditions warrants referral when suspected?
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What is the guideline for repeating blood pressure measurements if target organ damage is identified?
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What should be done if a patient declines ambulatory blood pressure monitoring (ABPM)?
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Study Notes
Hypertension Diagnosis and Management
- NICE recommends measuring blood pressure in both arms for hypertension diagnosis.
- A reading difference greater than 20 mmHg necessitates repeat measurements; if it persists, use the arm with the higher reading.
- Pathological causes of unequal readings include supravalvular aortic stenosis; heart auscultation is advised if discrepancies are found.
- If the initial reading exceeds 140/90 mmHg, take a second measurement; follow-up management is based on the lower reading.
- Offer ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) for patients with readings >= 140/90 mmHg.
Emergency Situations
- For readings at or above 180/120 mmHg, admit for specialist assessment if:
- Signs of retinal haemorrhage or papilloedema are present.
- Life-threatening symptoms like new confusion, chest pain, heart failure signs, or acute kidney injury occur.
- Referral is recommended if phaeochromocytoma is suspected, characterized by labile or postural hypotension, headache, palpitations, pallor, and diaphoresis.
- If there are no urgent concerns, arrange investigations for end-organ damage (e.g., blood tests, urine ACR, ECG).
- Initiate antihypertensive treatment immediately if target organ damage is identified; otherwise, repeat blood pressure measurement within 7 days.
Ambulatory Blood Pressure Monitoring (ABPM)
- Conduct at least 2 measurements per hour during waking hours (08:00 to 22:00).
- Use the average from at least 14 measurements for assessment.
Home Blood Pressure Monitoring (HBPM)
- If ABPM is not tolerated, offer HBPM.
- Ensure two consecutive measurements are taken at least 1 minute apart while seated.
- Record BP twice daily, preferably morning and evening, for 4 to 7 days.
- Discard the first day's measurements, using the average of the remaining readings for evaluation.
Interpreting Results
-
ABPM/HBPM readings >= 135/85 mmHg indicate stage 1 hypertension:
- Treatment is advised for those under 80 with target organ damage, established cardiovascular or renal disease, diabetes, or a 10-year cardiovascular risk of 10% or greater.
- A 2019 recommendation suggests considering antihypertensive treatment for adults under 60 with stage 1 hypertension and a risk below 10%, reflecting concerns about underestimated lifetime risks.
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ABPM/HBPM readings >= 150/95 mmHg indicate stage 2 hypertension:
- Drug treatment is recommended regardless of the patient’s age.
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Description
This quiz covers the NICE recommendations for measuring blood pressure in both arms. Learn about the implications of significant differences in readings and the possible pathological causes of unequal blood pressure. Test your understanding of proper procedures and conditions related to hypertension diagnosis.
