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Hypertension

Hypertension. Annual Scientific Assembly – MB April 11, 2008 Brent Kvern. Task #1. Using the provided stills – create the plot of the movie. Objectives. Critically exam something we do habitually Critically review the decisions we make based on BP measurements

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Hypertension

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  1. Hypertension Annual Scientific Assembly – MB April 11, 2008 Brent Kvern

  2. Task #1 • Using the provided stills – create the plot of the movie

  3. Objectives • Critically exam something we do habitually • Critically review the decisions we make based on BP measurements • Undertake a SAMP based on 2007 Canadian Hypertension Society Guidelines

  4. History BP monitoring • 1733 – Rev. Stephen Hales • Glass tube in a horse’s artery • 1834 – Hérisson & Gernier • First sphygmomanometer • 1870 – Mohamed • First to report increase in arterial pressure was an index of kidney damage • 1905 – Korotkoff • Describes the sounds detected when an arterial vessel is compressed

  5. Methods • Invasive catheterisation • Ausculatory method • Automated ausculatory method • Oscillometric method • Impedance plethysmography • Ambulatory blood pressure monitoring

  6. Task #2 • Pretend you are going to teach a first year medical student how to properly measure a patient’s blood pressure. • In groups, create a check list outlining each step of the “correct BP measurement technique” you will use to assess the medical student.

  7. Task #3 • SAMP (Short Answer Management Problems) • Write out an answer for each question asked. Be brief but clear.

  8. Dx – initial visit #1 • If hypertensive urgency / emergency → manage immediately • If SBP ≥140 &/or DBP ≥ 90 mm Hg → schedule HTN assessment 1 month plus next slide • If BP “hi-normal” in absence DM / CVD → follow annually

  9. Dx – initial visit #1 [BP raised] • If at visit #1 SBP ≥ 140 &/or DBP ≥ 90… • At least TWO more BP readings this visit, each at least 2 minutes apart, • Discard the first reading and average the latter two, • Search for target organ damage • U/A, Na, K, Cr, FBS, Cholesterol, EKG, waist circumference, weight, height SCHEDULE FOLLOW UP WITHIN A MONTH

  10. Dx – visit #2 • DM or GFR <60mL/min +SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg Diagnose as hypertensive and treat • Without DM or GFR <60mL/min + SBP ≥ 180 mm Hg and/or DBP ≥ 110mm HgDiagnose as hypertensive and treat • Without DM or GFR <60mL/min +SBP < 180 mm Hg and/or DBP < 110 mm Hg THEN ONE OF THREE OPTIONS: A, B or C

  11. Option A: Office blood pressure • If SBP ≥ 160 mm Hg and/or DBP ≥ 100 mm Hg average over 3 visits ….OR…. • If SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg average over 5 visits Diagnose as hypertensive and treat

  12. Option B: Ambulatory BP • If mean awake SBP ≥ 135 mm Hg and/or If mean awake DBP ≥ 100 mm Hg …..OR….. • If mean 24 hour SBP ≥ 130 mm Hg and/or If mean 24 hour DBP ≥ 80 mm Hg Diagnose as hypertensive and treat

  13. Option C: Home BP • Using the “B-4” method If average SBP ≥ 135 mm Hg and/or If average DBP ≥ 85 mm Hg Diagnose as hypertensive and treat

  14. Objectives • Critically exam something we do habitually • Critically review the decisions we make based on BP measurements • Undertake a SAMP based on 2007 Canadian Hypertension Society Guidelines

  15. Bibliography • Pickering TG et al. Ambulatory Blood Pressure monitoring. NEJM 2006;354(22):2368-74 • Parati G et al. Blood pressure measurement in research and in clinical practice: recent evidence. Curr Op Neph Htn 2004;13:343-57 • 2007 Canadian Hypertension Education Program. http://hypertension.ca/recommendations.html accessed March 4, 2007 • Campbell N. Accurate blood pressure measurement: why does it matter. CMAJ 1999;161(3):277-80 • Perloff D et al. Human blood pressure determination by sphygmomanometry. Circ 1993;88(5):2460-70 • Salt intake: the lower the better. http://www.jr2.ox.ac.uk/bandolier/booth/hliving/saltbp.html accessed March 4, 2008 • Lewis J et al. Evaluation of community based automated blood pressure device. CMAJ 2002;166(9):1145-8 • Allison C. BpTRU™ blood pressure monitor for use in physician’s office. Issues Emerg health Technol 2006;86:1-4 • Reims H et al. Home blood pressure monitoring. Jour Htn 2005;23:1437-9

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