Definition and Diagnosis of Hypertension

Definition and Diagnosis of Hypertension

Definition and Diagnosis of Hypertension

This Harvard Medical School Continuing Education video examines these key questions: What is the proper technique for measuring blood pressure? How is hypertension diagnosed? What are the defining characteristics and risk factors associated with white coat hypertension and masked hypertension?

Dr. Michael Honigberg, MD, a cardiologist at Massachusetts General Hospital, steps through the proper technique for measuring blood pressure, explains the current ACC/AHA guidelines for diagnosing hypertension, and defines terms used to classify stage 1 and stage 2 hypertension. Options for home blood pressure monitoring and ambulatory blood pressure monitoring are discussed in relation to identifying the indicators of normotension, sustained hypertension, white coat hypertension and masked hypertension.

This video was peer reviewed by Dr. Jonathan Salik, TMD, MHPEd, Instructor of Medicine, Massachusetts General Hospital; and Dr. Sugantha Sundar, MD, Assistant Professor of Anesthesia, Beth Israel Deaconess Medical Center, to validate the quality and accuracy of the content.

00:00 | Introduction
00:48 | Definition of blood pressure
01:14 | Complications of high blood pressure
01:35 | Proper technique for measuring blood pressure
02:20 | Diagnosing and classifying hypertension
03:03 | Home and ambulatory blood pressure monitoring
04:12 | Normotension, sustained hypertension, white coat hypertension, and masked hypertension

References:
GBD 2018 Disease and Injury Incidence and Prevalence Collaborators. Global Burden of Disease Study, Lancet. 2018;392(10159):1683-2138.  

Centers for Disease Control and Prevention. Measure your blood pressure. CDC website. https://www.cdc.gov/bloodpressure/mea…

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:127-248.

Notice: At this time, the content in this video is not accredited.


Content

0 -> [MUSIC PLAYING]
3.241 ->
5.613 -> MICHAEL HONIGBERG: Hi.
6.53 -> I'm Dr. Michael Honigberg.
7.82 -> I'm a cardiologist at the Massachusetts General Hospital
10.4 -> in Boston, Massachusetts.
12.14 -> Today, we'll be talking about a topic that's
14.15 -> fundamental to the practice of medicine, blood pressure.
17.75 -> Specifically, we'll be covering the definition and diagnosis
20.63 -> of hypertension as outlined in the 2017 American
24.5 -> College of Cardiology/American Heart Association guidelines
27.56 -> for the management of blood pressure.
29.69 -> Our objectives today will be for you
31.31 -> to understand how to perform proper technique for measuring
34.1 -> blood pressure, correctly apply the 2017 ACC/AHA
39.05 -> guidelines to diagnose and classify hypertension,
42.71 -> and review the concepts of white coat hypertension
45.68 -> and masked hypertension.
49.43 -> When the heart pumps blood through the arteries,
51.71 -> the blood puts pressure on the artery walls.
53.93 -> This is known as blood pressure.
55.98 -> Blood pressure is reported as two numbers,
58.16 -> both in units and millimeters of mercury.
60.53 -> The top number is the systolic blood pressure,
62.9 -> representing pressure when the heart is ejecting blood
65.51 -> into the arterial system.
67.52 -> The bottom number is the diastolic blood pressure,
69.92 -> representing pressure when the heart is relaxing, diastole.
73.73 -> Complications of high blood pressure
75.71 -> include ischemic heart disease, including
78.65 -> myocardial infarction, stroke, peripheral artery disease,
82.85 -> aortic aneurysm and dissection, heart failure,
86.21 -> and chronic kidney disease.
87.83 -> On a global scale, elevated blood pressure
90.17 -> is the most common risk factor for death and disability
92.81 -> worldwide.
95.068 -> Correct measurement of blood pressure
96.61 -> is important when evaluating and managing patients.
99.22 -> First, prepare.
101.05 -> Ideally, the patient should have an empty bladder
103.51 -> and not have consumed caffeine or exercised within the last 30
107.11 -> minutes.
107.99 -> The patient should sit supported for at least five minutes
111.52 -> with feet on the floor and back well-supported.
116 -> Measure the blood pressure correctly.
117.83 -> Ensure the correct cuff size and that 80% of the cuff's bladder
121.82 -> fits around the patient's upper arm.
123.74 -> The cuff should sit on bare skin.
126.47 -> No talking during measurement of the blood pressure.
129.62 -> Measure blood pressure in both arms,
131.57 -> and use the higher reading to guide medical decision-making.
135 -> If the blood pressure is elevated,
136.58 -> repeat measurement after at least one to two minutes.
140.12 -> Now you've measured your patient's blood pressure,
142.29 -> how do you interpret the readings?
144.02 -> The 2017 ACC/AHA guidelines define hypertension
148.49 -> as a systolic blood pressure greater than
150.5 -> or equal to 130 millimeters of mercury
153.83 -> or a diastolic blood pressure greater than
156.47 -> or equal to 80 millimeters of mercury.
159.11 -> The guidelines further define four categories
162.11 -> of blood pressure--
163.61 -> normal, elevated, stage 1 hypertension,
167.84 -> and stage 2 hypertension, indicating
170.39 -> more severe hypertension.
171.98 -> Stage 2 is defined as a systolic blood pressure greater than
175.13 -> or equal to 140 millimeters of mercury
177.92 -> or a diastolic blood pressure greater than
179.87 -> or equal to 90 millimeters of mercury.
183.38 -> The guidelines further endorse the use
186.11 -> of blood pressure measured outside the office
188.84 -> to confirm a diagnosis of hypertension in some patients
191.93 -> and to monitor response to treatment.
194.03 -> A couple of different options are
195.53 -> available for out-of-office blood pressure measurement.
198.35 -> The terminology here can be a little bit confusing.
201.14 -> Home blood pressure monitoring typically
203.51 -> refers to self-measurement of blood pressure
205.82 -> by the patient using a validated device.
209.28 -> Ambulatory blood pressure monitoring, by contrast,
212.41 -> refers to measurement of out-of-office blood pressures
215.07 -> using a temporary monitor prescribed by the physician
218.31 -> or clinician that monitors the blood pressure regularly at set
222.12 -> intervals, such as every 30 or 60 minutes over a period of 24
226.29 -> hours.
227.82 -> As summarized in this table included in the guidelines,
231.06 -> it's expected that blood pressures measured
232.89 -> in the office might be a little bit higher on average
235.29 -> than blood pressures measured at home,
237.06 -> and so thresholds for normal and elevated blood pressures
240.06 -> differ depending on in-office versus
242.64 -> out-of-office measurement.
244.65 -> Note as well that nighttime ambulatory blood pressures
248.01 -> tend to be lower on average than daytime ambulatory blood
251.01 -> pressures.
252.64 -> So how do we put all these numbers together?
254.95 -> If a patient has normal blood pressures, both in the office
258.31 -> and in the out-of-office setting,
260.14 -> they are called normotensive.
262.42 -> If a patient has hypertension both in the office setting
265.24 -> and in the non-health care setting,
267.44 -> they have what we call sustained hypertension.
270.65 -> But what if there's discordance?
272.68 -> White coat hypertension refers to the situation
275.17 -> where a patient has elevated blood pressures in the office,
278.2 -> but normal blood pressures on out-of-office measurement.
281.44 -> Again, this is called white coat hypertension.
284.47 -> It's worth noting that a recent meta analysis suggested
288.04 -> that untreated white coat hypertension is associated
291.46 -> with excess cardiovascular disease
293.41 -> risk compared to patients with solid normotension.
296.23 -> So this is a population not to be ignored
298.96 -> who may benefit from additional monitoring or lifestyle
301.84 -> interventions.
302.71 -> We'll talk more about the management of elevated blood
305.08 -> pressure in another section.
308.03 -> Finally, masked hypertension refers
310.48 -> to a situation where a patient has normal blood
312.88 -> pressures measured in the office,
314.62 -> but true hypertension outside the office.
317.62 -> This condition is associated with the same excess risk
320.32 -> of cardiovascular disease as sustained hypertension
323.05 -> and merits treatment.
326.08 -> In summary, in this video, we learned
328.33 -> how to perform proper technique for measuring blood pressure,
331.48 -> how to apply the 2017 ACC/AHA guidelines to correctly
336.25 -> diagnose and classify degree of hypertension,
339.4 -> and review the concepts of white coat hypertension
342.01 -> and masked hypertension.
344.69 -> Thank you for watching today.
346.17 -> I hope you found this video educational.
349.39 ->

Source: https://www.youtube.com/watch?v=K3qIFlWVSYk