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Chapter 5. Hypertension

Student Questions

A 55-year-old white man with seated office blood pressure (BP) readings of 138/89 mm Hg and 136/84 mm Hg is asked to return in 2 weeks for repeat measurements, which are 138/88 mm Hg and 134/82 mm Hg. Which of the following classifies his BP per the 2017 ACC/AHA guidelines?

A. Stage 2 hypertension

B. Stage 1 hypertension

C. Elevated BP

D. Optimal BP

Answer: B

Option A: Incorrect. Stage 2 hypertension is defined as systolic BP greater than 140 mm Hg or diastolic BP greater than 90 mm Hg.

Option B: Correct. The patient's average BP falls within the range of systolic BP of 130–139 mm Hg or diastolic BP of 80–89 mm Hg, defined as stage 1 hypertension.

Option C: Incorrect. Elevated hypertension is defined as systolic BP of 120–129 mm Hg and diastolic BP of less than 80 mm Hg.

Option D: Incorrect. Optimal BP is defined as BP less than 120 in systolic and less than 80 mm Hg in diastolic.

A 34-year-old black man presents to your clinic with a BP of 160/94 mm Hg. Repeat readings over the past 2 weeks average 156/92 mm Hg. The patient has no past medical history with the exception of Crohn disease, which is currently treated with chronic steroid therapy. He is also taking an over-the-counter NSAID for ongoing back pain. Physical examination and laboratory tests are unremarkable. Appropriate interventions at this time include:

A. No intervention because patient most likely has drug-induced hypertension

B. NSAID is appropriate as long as he follows the instructions on the package insert

C. Reassessment of the dose and need for long-term oral steroids

D. Initiation of antihypertensive therapy

Answer: C

Option A: Incorrect. Consistent elevations in BP require intervention with either treatment or evaluation of whether hypertension is secondary to alternative cause.

Option B: Incorrect. NSAID should be avoided as this can result in elevated BP and an increased risk of cardiovascular events.

Option C: Correct. It is reasonable to inquire for the need of long-term steroids and dose as this is a possible secondary cause for elevated blood pressures.

Option D: Incorrect. Prior to initiation of therapy, the secondary cause of hypertension should be ruled out or reassessed to see if treatment is necessary.


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