CC March 2016 White Coat Hypertension

echoecho's version from 2016-04-28 02:14


Question Answer
It is common for patients to have elevated BP readings when in a _____ setting but report normal readings when they are going about their normal activities. The availability and ease of use of home BP monitoring devices have highlighted these discrepancies?medical
Define white coate hypertension (WHC)?elevated BP (> 140/90) in the clnical setting with normal blood pressure in the ambulatory setting
A recent European group further defines normal 24-hour ambulatory BP as < ___/_________?130/80
Why is identifying patients with WCH important?so that overtreatment of BP does not occur
WCH accounts for about ____% of all cases of HTN?20
It appears to be more prevalent in what gender? what age group? smokers vs nonsmokers? pregnant vs. nonpregnant?women; older adults; nonsmokers; pregnancy
What monitoring can assess BP ouside the medical setting?self-blood pressure
The monitor should be checked for what and the patient should be instructed about what?accuracy; the proper technique for obtaining a good baseline BP reading
*** Diagnosing WCH is one of the indications for what monitoring?ambulator BP monitoring
If the 24-hour average is < ____/____ , daytime average is < ___/90 and nighttime average is < ____/____?, the patient does not have sustained HTN and a dx of WCH can be made?< 135/85; < 140/90; < 125/75
In one study of elderly patients, ___% of patients found to be HTNsive in the medical setting were found to have WCH on ambulatory blood pressure monitoring?72%
A study of 309 patients referred for ABPM investigated whether the use of an automated BP device with the patient resting in a room alone with the device would eliminate the white coat BP response. What was the study's results?found that BP readings taken in this manner correlated very well with the mean BP recorded on ABPM and were significantly lower than BP readings recorded by the patient's physician
Controversy exists regarding the cardiovascular risks of WCH. What did a 2014 study find?1) higher left ventricular wall index 2) higher lipid levels 3) decreased arterial compliance 4) impaired fasting glucose
*** While this suggests a greater cardiovascular risk related to WCH, it appears to be significantly _____ than that associated with sustained hypertension. It is also clear that ____% of patients with WCH progress to sustained HTN and thereby assume associated risk?1) less 2) 50
Patients at increased risk for progression include what patient types?1) higher average daytime and nighttime ABPM 2) individuals who are middle-aged or elderly 3) those having associated metabolic risks
A dx of WCH is not valid without what?documentation of normal readings outside the medical setting
Individuals diagnosed with WCH should be encouraged to do what? initiate lifestyle modifications if appropriate (smoking cessation, weight loss, dietary modification)
Close follow-up is necessary to monitor for what?progression
*** SUMMARY = Define white coat hypertension?elevated BP (>140/90) in the clinical setting with normal BP in the ambulatory setting
*** SUMMARY = What type of monitoring is useful in diagnosing WCH?1) self-blood pressure monitoring 2) ambulatory BP monitoring
*** SUMMARY = True or false? Controversy exists regarding the cardiovascular risks of WCH?true