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Hypertension Diagnosis and Classification

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153 Questions

What is the medical term for high blood pressure with a persistent elevation of the systolic and/or diastolic BP?

Hypertension

At what systolic and diastolic pressure is hypertension medically diagnosed?

140mmHg or higher and 90mmHg or higher

What is the blood pressure range considered normal for seniors?

140-160/90 or less

At what age does a child's blood pressure typically reach adult values?

In a teenager

What is the category of hypertension classified as PRIMARY also referred to as?

Essential, Idiopathic, or Benign

What is the normal blood pressure range for a 6-9 year old child?

122/78

Hypertension is medically diagnosed if the systolic pressure is ______ mmHg or higher and the diastolic pressure is 90 mmHg or higher.

140

As kids grow, their blood pressure continues to increase from a systolic pressure of about ______ in an infant.

90

A diagnosis of Hypertension will be classified as ______, SECONDARY, or Malignant.

PRIMARY

A child is at risk for hypertension at much lower blood pressures, such as ______ for 3 to 5 years.

116/76

The normal blood pressure range for a 10-12 year old child is ______.

126/82

Seniors have blood pressure readings that are higher than adult readings because blood vessels become less ______ combined with other age-related changes.

compliant

Hypertension is classified as PRIMARY, SECONDARY, or Benign.

False

A diagnosis of hypertension will be classified as PRIMARY, SECONDARY, or Stage 3 (Class 3, Severe).

False

The normal blood pressure range for children remains the same from infancy to adolescence.

False

Blood vessels become more compliant with age, resulting in higher blood pressure readings in seniors.

False

A systolic pressure of 160 mmHg or higher is considered hypertension in seniors.

True

A diagnosis of hypertension requires a single blood pressure reading of 140/90 mmHg or higher.

False

What is the effect of arteriosclerosis and arteriolosclerosis on blood vessels?

Thickening and hardening of blood vessels

What is the consequence of damage to nephrons in the kidneys?

Systemic fluid retention

What is the effect of hypertension on the Central Nervous System?

Transient Ischemic Attacks and Stroke

What is the result of atherosclerotic plaques on renal arteries?

Decreased blood flow to the kidneys

What is the consequence of excessive release of renin in the kidneys?

Increased blood pressure and vasoconstriction

What is the effect of hypertension on the heart?

Angina Pectoris and Acute Myocardial Infarction

Hypertension is often called the "Silent ______" because it often has few recognizable signs.

Killer

_______ and arteriolosclerosis result from high pressures to blood vessel walls or irritants which result in damage or lesions.

Arteriosclerosis

Over time, thickening, hardening, as well as reduced space, (_______), for blood to pass through results in tissue ischemia downstream from obstruction.

lumen

Atherosclerotic plaques on renal arteries cause decreased blood flow to kidneys, tissue damage, and decreased ______.

function

Excessive release of renin results in vasoconstriction, water and salt retention, edema, increased blood volume, and increased ______ pressure.

blood

Transient ischemic attacks are also known as mini ______.

strokes

Hypertension can cause damage to the kidneys due to atherosclerotic plaques on renal veins.

False

Transient ischemic attacks are also known as mini heart attacks.

False

Hypertension can cause increased risk of congestive heart failure in the heart.

True

Damage to nephrons in the kidneys results in increased blood pressure due to the release of a hormone that regulates blood sugar balance.

False

Arteriosclerosis and arteriolosclerosis result from low pressures to blood vessel walls or irritants.

False

Hypertension is often called the 'Silent Healer' because it often has few recognizable signs.

False

What percentage of all cases of hypertension is accounted for by Primary Hypertension?

90-95%

What is a major risk factor for Primary Hypertension?

Family History

What is a common symptom of Primary Hypertension?

All of the above

What is a long-term complication of Primary Hypertension?

All of the above

What is a lifestyle modification that can help control Primary Hypertension?

Reducing Sodium Intake

What is the percentage of deaths caused by Chronic Congestive Heart Failure in people with Primary Hypertension?

60%

Primary Hypertension Accounts for ______ % of all cases of hypertension.

90-95

Combining ______ increases the risk of Primary Hypertension.

risk factors

People may not know they have Primary Hypertension until a complication arises ______ to the hypertension.

secondary

Chronic, slow, progressive damage to blood vessels and then ______ organs is a long-term complication of Primary Hypertension.

vital

Lifestyle modification may include ______ reduction to control Primary Hypertension.

weight

Death in 20-40 years due to Primary Hypertension is typically caused by ______ Congestive Heart Failure or Cerebral Hemorrhage.

Chronic

Idiopathic primary hypertension accounts for 95-100% of all cases of hypertension.

False

Cigarette smoking is a sign of primary hypertension.

False

The complication of primary hypertension that leads to 10% of deaths is kidney/liver/lung failure.

True

Lifestyle modification can be used solely to control stage 2 hypertension or higher.

False

Primary hypertension can cause damage to the kidneys due to atherosclerotic plaques on renal veins.

False

Primary hypertension is often called the 'Silent Killer' because it often has few recognizable signs.

True

What percentage of cases of hypertension is accounted for by secondary hypertension?

5-10%

What is the effect of calcium channel blockers on cardiac and smooth muscle?

Inhibit movement of calcium into

What is a common symptom of malignant hypertension?

All of the above

What is the consequence of untreated malignant hypertension?

Death in a few days to a few years

What is the effect of ACE inhibitors on blood vessels?

Reduce vasoconstriction

What is the cause of death in patients with untreated hypertension?

All of the above

_______ is when blood pressure rises quickly and can be potentially fatal.

Malignant hypertension

Medications such as ______ inhibitors reduce vasoconstriction.

ACE

Secondary hypertension accounts for ______ % of cases.

5-10

Death is usually due to ______ Failure or Cerebral Hemorrhage or acute congestive heart failure.

Kidney

Calcium Channel blockers inhibit movement of ______ into cardiac and smooth muscle.

calcium

Vasodilators reduce ______ vascular resistance.

peripheral

Diabetes is a complication of Secondary Hypertension.

False

ACE inhibitors increase vasoconstriction.

False

Transient ischemic attacks are a symptom of Primary Hypertension.

False

Calcium Channel blockers increase the movement of calcium into cardiac and smooth muscle.

False

Malignant hypertension is a complication of Primary Hypertension.

False

Vasodilators increase peripheral vascular resistance.

False

What is the purpose of taking a client's blood pressure before and after each massage treatment?

To monitor the client's response to the massage

What is a common cause of false high blood pressure readings?

Recording BP immediately after a meal

What should a therapist do if a client's blood pressure reading is high?

All of the above

What is a lifestyle modification that may be recommended to clients with hypertension?

All of the above

What is the term for the fear of taking blood pressure, which can cause false high readings?

White Coat syndrome

Why should a therapist ask a client about recent activities and caffeine intake before taking their blood pressure?

To ensure accurate blood pressure readings

The client should be referred to a ______ if there is a change in their BP reading from previous readings.

physician

The BP reading is taken again, and if it remains high, ______ modifications are made and the client is referred to their physician.

treatment

In clinic, let your ______ know if you get a high reading.

supervisor

“White Coat” syndrome is the fear of taking ______.

BP

The therapist asks the client about recent ______, caffeine intake, cigarette smoking.

activities

Recording BP while person’s ______ is full may cause a false high reading.

bladder

The client should be referred to a nurse if there is a change in their BP reading from previous readings

False

A systolic pressure of 140 mmHg or higher is considered hypertension in seniors

False

The BP reading should be taken immediately after a meal, cigarette, stressful event, or physical activity

False

Deflating the cuff quickly can cause false high readings

False

The therapist asks the client about recent activities, caffeine intake, and sleeping position before taking their blood pressure

False

Blood vessels become less compliant with age, resulting in higher blood pressure readings in seniors

False

What is a sign of cardiac distress during a massage treatment?

Rapid pulse

What should the therapist do if a client shows signs of cardiac distress during treatment?

Position the client in a semi-seated or seated position and discontinue treatment

What type of hypertension is completely contraindicated for massage treatment?

Severe (Stage 3) hypertension

What should the therapist monitor before and after a massage treatment for a client with mild hypertension?

The client's blood pressure

What type of hypertension requires positioning, hydrotherapy, and technique modifications for massage treatment?

Moderate (Stage 2) hypertension

What should the therapist do if the client's symptoms do not subside after discontinuing the massage treatment?

Call 911 immediately

Clients who have a ______ condition or hypertension should be monitored during the massage.

heart

If a client shows signs of ______ distress during treatment, position in semi-seated or seated and discontinue treatment.

cardiac

Moderate (Stage 2) hypertension that is uncontrolled/unstable is completely ______ for treatment.

CI'd

Severe (Stage 3) or Very Severe (Stage 4) hypertension is always ______ for treatment.

CI'd

Mild hypertension that is controlled and stable with medication usually requires no ______ modifications.

treatment

Call 911 if symptoms of cardiac distress do not ______ during treatment.

subside

Clients with Mild hypertension that is controlled and stable with medication usually require technique modifications.

False

If a client shows signs of cardiac distress during treatment, the therapist should continue with the massage even if the client states they feel alright.

False

Severe (Stage 3) hypertension is always contraindicated for treatment, but can be modified by the patient's doctor and the blood pressure reading taken by the therapist prior to treatment.

False

Moderate (Stage 2) hypertension that is controlled and stable with medication is completely contraindicated for treatment.

False

Tissue bogginess and edema post-massage are signs of cardiac distress during treatment.

True

If the client's symptoms of cardiac distress do not subside, the therapist should call the client's doctor instead of 911.

False

What is the purpose of taking blood pressure before and after each treatment?

To assess the effectiveness of the treatment

Why should the therapist avoid elevating the client's limbs above the heart for prolonged periods?

To prevent dramatic increases in venous return

What is the purpose of working distal to proximal and using segmental massage techniques?

To avoid dramatic increases in venous return

Why should the therapist avoid abdominal pillowing?

To compress the abdominal aorta

What should the therapist do if they notice signs of cardiac distress during treatment?

Position the client in a semi-seated or seated position and discontinue treatment

What is the purpose of dividing the back into boxes when working on the back?

To avoid long strokes and work segmentally

The aims of treatment include taking blood pressure before and after each _______________

treatment

The therapist should avoid abdominal _______________ as it compresses the abdominal aorta

pillowing

To decrease peripheral vascular resistance, the therapist should start with a hand and/or foot _______________

massage

When working on the back, the therapist works segmentally, avoiding long _______________

strokes

The therapist should remain vigilant for any signs of cardiac _______________ throughout the treatment

distress

Any potentially painful techniques are limited and interspersed with _______________ techniques

soothing

What is the approximate normal blood pressure reading?

90/60

What is the term for a sudden fainting due to hypotension induced by a nervous system response?

Vasovagal Syncope

What is the drop in systolic blood pressure that indicates Orthostatic Hypotension?

20mmHg

What is the underlying cause of Orthostatic Hypotension?

Abnormal blood pressure regulation due to various causes

What is the warning sign of Vasovagal Syncope?

Nausea, blurred vision, lightheadedness, and sweating

What happens to blood when a person assumes an upright posture from a supine position?

It shifts to the lower part of the body

Which of the following groups is more susceptible to experiencing hypotension when assuming a sudden upright position?

Elderly patients with severe varicose veins

What is a recommended precaution to prevent injury when getting a client off the massage table?

Offer to assist the client off the table

What can be done to help normalize blood flow when getting a client off the massage table?

Have the client sit at the edge of the table and move their legs

Why should a massage therapist inform a client about possible dizziness when getting up from the massage table?

To prepare the client for possible symptoms of hypotension

What is a recommended way to facilitate a client's transition from a supine to an upright position?

Gradually assist the client to a standing position

After assuming an upright posture from supine, approx. 500-700ml of blood momentarily shifts to the lower part of the ______.

body

Some clients may experience symptoms of hypotension when getting off the ______ table after laying down for the duration of treatment.

massage

Be prepared and offer to assist the client off the ______ to prevent injury.

table

Have the client sit at the edge of the ______ and move legs to assist in skeletal muscle contraction to normalize blood flow.

table

Encourage gradual movement to a ______ position and inform the client of possible dizziness from getting up too quickly.

standing

Clients with ______ varicose veins may experience symptoms of hypotension when getting up too quickly.

severe

A decrease in the Systolic/Diastolic BP below normal (approx. ______/60) is known as Hypotension.

90

One of the severe cases of hypotension includes ______ Infarction.

Acute Myocardial

Vasovagal Syncope is a type of fainting due to hypotension induced by a nervous system response to ______ stress, pain or trauma.

abrupt emotional

Orthostatic Hypotension is characterized by an excessive fall in BP on assuming a sudden ______ position.

upright

In Orthostatic Hypotension, a drop of ______mmHg in Systolic pressure is considered significant.

20

Vasovagal Syncope is accompanied by a rapid heart rate

False

Hemorrhage is a mild case of hypotension

False

Orthostatic Hypotension is a disease

False

A drop of 15mmHg in Systolic pressure is a diagnostic criterion for Orthostatic Hypotension

False

Acute Myocardial Infarction is a mild case of hypotension

False

After assuming an upright posture from supine, approx. 1000-1200ml of blood momentarily shifts to the lower part of the body

False

Clients with severe diabetes may experience symptoms of hypotension when getting up too quickly

True

Assisting the client off the table can help prevent injury due to hypotension

True

Symptoms of hypotension include headaches and nausea

False

Gradual movement to a standing position can help prevent hypotension

True

Hypotension is commonly seen in clients with severe hypertension

False

Study Notes

Hypertension Classification

  • Classified by severity: Stage 1 (Mild), Stage 2 (Moderate), Stage 3 (Severe), and Stage 4 (Very Severe)
  • Diagnosis: Systolic pressure ≥140 mmHg and Diastolic pressure ≥90 mmHg after 2-3 consecutive visits
  • Classification also includes Primary (Essential, Idiopathic, or Benign), Secondary, and Malignant hypertension

Blood Pressure Ranges

  • Normotension: Systolic <120 mmHg and Diastolic <80 mmHg
  • High Normal: Systolic 120-139 mmHg and Diastolic 80-89 mmHg
  • Stage 1 Hypertension: Systolic 140-159 mmHg and Diastolic 90-109 mmHg
  • Stage 2 Hypertension: Systolic 160-179 mmHg and Diastolic 110-119 mmHg
  • Stage 3 Hypertension: Systolic 180-209 mmHg and Diastolic 120-129 mmHg
  • Stage 4 Hypertension: Systolic ≥210 mmHg and Diastolic ≥130 mmHg

Hypertension in Children and Seniors

  • Children: Blood pressure increases with age, and hypertension is diagnosed at lower pressures
    • 3-5 years: 116/76 mmHg
    • 6-9 years: 122/78 mmHg
    • 10-12 years: 126/82 mmHg
    • 13-15 years: 136/86 mmHg
  • Seniors: Blood pressure is higher than adults, and hypertension is diagnosed at ≥140/90 mmHg

Complications of Hypertension

  • Damage to blood vessels: Arteriosclerosis and Arteriolosclerosis
  • Heart: Angina Pectoris, Acute Myocardial Infarction, Acute Pulmonary Edema, and Congestive Heart Failure
  • Kidneys: Atherosclerotic Plaques on Renal Arteries, Decreased Blood Flow, Tissue Damage, and Decreased Function
  • Central Nervous System: Transient Ischemic Attacks, Stroke, and Cognitive Decline

Primary Hypertension

  • Accounts for 90-95% of cases
  • Cause: Idiopathic (unknown)
  • Risk Factors: Biological sex, Race, Age, Family History, Emotional/Physical Stress, Obesity, Cigarette Smoking, and others

Secondary Hypertension

  • Accounts for 5-10% of cases
  • Causes: Secondary complication to an underlying condition, such as Diabetes, Atherosclerosis, Kidney Disease, and others
  • Malignant Hypertension: Rapidly progressing and potentially fatal

Medical Treatment

  • Lifestyle Modification: Weight reduction, Reduced sodium intake, Reduced alcohol intake, Cessation of smoking, Regular physical activity, and Stress management
  • Medications: Diuretics, Beta Blockers, Calcium Channel blockers, Vasodilators, and ACE inhibitors

Case History Questions

  • General health

  • Age

  • Date diagnosed

  • Last physical and B/P reading

  • Medications and compliance

  • Restrictions and lifestyle modifications

  • History of massage and response to it

  • Other associated symptoms### Cardiac Distress Warning Signs

  • Increased heart rate

  • Dizziness

  • Rapid pulse

  • Labored shallow breathing

  • Sweating or clamminess of the skin

  • Cyanosis (lips and face turn blue)

  • Tissue bogginess and edema post-massage

Contraindications and Precautions

  • Moderate (Stage 2) hypertension that is uncontrolled/unstable is completely contraindicated for treatment
  • Severe (Stage 3) or Very Severe (Stage 4) hypertension is always contraindicated for treatment
  • Mild hypertension that is controlled and stable with medication usually requires no treatment modifications, but blood pressure should be monitored before and after treatment
  • Moderate hypertension requires positioning, hydrotherapy, and technique modifications

Modified Massage for Clients with Hypertension

  • Positioning, hydrotherapy, and technique modifications are required for moderate hypertension
  • Limited time in prone position (10 minutes) may be used for mild controlled hypertension that is stable
  • Avoid elevating limbs above the heart for prolonged periods
  • Avoid abdominal pillowing as it compresses the abdominal aorta
  • Avoid prolonged neck stretches or deep anterolateral neck techniques
  • Aims of treatment include taking blood pressure before and after each treatment, decreasing sympathetic nervous system firing, and decreasing peripheral vascular resistance

Hypotension

  • A decrease in systolic/diastolic blood pressure below normal (approximately 90/60)
  • Causes include Acute Myocardial Infarction, Hemorrhage, and Allergic response
  • Vasovagal Syncope: sudden fainting due to hypotension induced by nervous system response to abrupt emotional stress, pain, or trauma
  • Orthostatic (postural) Hypotension: an excessive fall in BP on assuming a sudden upright position

Precautions and Treatment Modifications for Hypotension

  • Be prepared to assist clients off the table to prevent injury
  • Encourage gradual movement to a standing position and inform clients of possible dizziness from getting up too quickly
  • Have clients sit at the edge of the table and move their legs to assist in skeletal muscle contraction to normalize blood flow

Test your knowledge on hypertension, its classification, diagnosis, and severity. Learn about the criteria for diagnosing hypertension and its different types.

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