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CC May 2018 Masked and White Coat Hypertension

echoecho's version from 2018-05-01 09:13


Question Answer
In 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) released a new guideline for HTN. Based on the current knowledge of the implications of BP elevation, this guideline defines new categories of BP for adults. The numbers defining these categories are substantially lower than those in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of HIgh blood pressure, JNC-7. List these new categories?1) Normal category (SBP < 120 AND DBP < 80) 2) ELEVATED (SBP 120-129 AND DBP < 80) 3) Stage 1 HTN (SBP 130-139 OR DBP 80-89) 4) STAGE 2 HTN (SBP > 140 OR DBP > 90)
In addition to those with sustained HTN, the guidline recognizes 2 other groups of individuals who have elevated BP readings but do not meet the criteria for sustained HTN , list these two? 1) masked HTN. 2) white coat HTN
Define masked HTN?Is defined as normal office BP but elevated out-of-office BP
Define white coat HTN?Is defined as an elevated office BP but out-of-office readings that are normal
For individuals already diagnosed with HTN there can be?1) masked uncontrolled HTN where in-office readings are at target, but out of office readings are elevated 2) white coat effect when BP readings in the office are higher than the out-of-office readings
*** The prevalence of masked HTN is estimated at ___ to ___% according to population based surveys?10; 26
*** Most concerning is the finding that the risks of cardiovascular disease (CVD) and all-cause mortality in this group are similar to those in the group with ______ HTN and about twice that of normotensive individuals?Sustained
The higher the in-office BP readings, the higher the prevalence of _____ HTN?Masked
In view of these concerns, correctly identifying individuals w/ masked HTN is important and best done with what monitoring?Home BP monitoring or with Ambulatory blood pressure monitoring
Both home BP monitoring and ambulatory BP monitoring appear to be better predictors of ____ risk than in-office BP readings?CVD
Ambulatory BP monitoring may help confirm findings of Home BP monitoring and predict ____ risk, but its availability is limited?CVD
One of the issues w/ masked HTN is identifying the individuals who need to be screened using home BP monitoring or ambulatory BP monitoring even when in-office readings are normal, true or false?True
There are no defined criteria for screening, but what criteria have been proposed?1) those who have a 10-6ear CVD risk >10%. 2) presence of conditions associated with HTN (metabolic syndrome) 3) high in-office BP readings 4) presence of other risk factors (male sex, smoking, diabetes)
The 2017 guideline states that screening for masked HTN w/ HBPM (or ABPM) is reasonable in adults w/ untreated office BPs consistently between ____ and ____ for systolic BP or between ____ and ___ for diastolic BP?120-129; 75-79
*** The 2017 guideline suggests the following for management of individuals suspected of masked HTN with in-office BP readings of 120-129 systolic and < 80 diastolic, list the management? : 3 month trial of life style modifications followed by daytime ABPM or HBPM. If the BP is > 130/80, the dx of masked HTN is made
Question Answer
Lifestyle modifications should be continued and initiation of an antihypertensive is also recommended (Class II b recommendation), defined as a weak recommendation but may be reasonable) if out-of-office BP remains elevated or the 10 year CVD risk is above ____%?10
If SBP is 120-129 and diastolic < 80, the dx of elevated BP is made, and it is recommended that lifestyle modifications continue but that ABPM is measured _____ to detect masked HTN?Annually
The weak recommendation to start pharmacotherapy is based on the fact that there is minimal supportive evidence demonstrating outcomes benefit, true or false?True
The prevalence of white coat hypertension (WCH) increases with age and is higher in what 2 groups of people?Women and non smokers
Some studies have found mildly increased risk of _____ complications and all-cause mortality?CVD
The use of HBPM and ABPM has documented a conversion rate of WCH to sustained HTN of ___ to ___% per year with a higher rate of conversion in patients who are older or have higher BP readings?1; 5
The 2017 guideline makes the following recommendations for management of patients w/ suspected WCHw/ in-office readings > ___/___ but < ____ /___?130/80; 160/100
List the management of for WCH?3 month trial of lifestyle modifications followed by daytime ABPM or HBPM and if those BP readings are < 130/80, the dx of WCH is made
LIfestyle modifications should continue and annual ABPM or HBPM is recommended to detec _______?Progression (class IIa recommendation - moderate recommendation)
If the BPM or HBPM is > 130/80 the dx of ____ is made?HTN
Lifestyle modifications should continue and antihypertensive therapy may be initiated (class IIa recommendations) depending upon ______ factors?Risk
*** SUMMARY = True or false? In 2017, the American College of CArdiology / American Heart Association (ACC/AHA) released updated HTN guidelines including new categories of elevated BP measurements?True
*** SUMMARY = Masked HTN is defined as what?Normal in-office BP and elevated out-of-office BP
*** SUMMARY = Masked HTN is associated with increased risk of _____ and all-cause morality equal to those associated with _____ HTN?Sustained
*** SUMMARY = White coat HTN is defined as ?Elevated BP in office but normal out-of office BP
*** SUMMARY = Patients with white coat HTN develop HTN at a rate of ___ to ___% annually?1; 5