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Introduction to Hypertension & the JNC 7

Audio Link   This audio segment gives a brief overview of Hypertension & the JNC 7. It discusses both the prevalence of hypertension and the relationship between blood pressure and the risk of cardiovascular disease. It also describes the JNC 7. (Running Time: 0:57)

JNC 7

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure attempts to provide an evidence-based approach to the prevention and management of hypertension.

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What is JNC 7? | Who makes up the JNC 7? | Why JNC 7?

The definition of hypertension

Question 1:

What is the definition of hypertension? (Choose the one best answer)

  1. Systolic blood pressure greater than 150 or diastolic blood pressure greater than 80.
  2. Systolic blood pressure greater than 130 or diastolic blood pressure greater than 80.
  3. Systolic blood pressure greater than 140 or diastolic blood pressure greater than 80.
  4. Systolic blood pressure greater than 140 or diastolic blood pressure greater than 90.
  5. Systolic blood pressure greater than 130 or diastolic blood pressure greater than 70.
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The correct answer is D. A systolic blood pressure greater than 140 or a diastolic blood pressure greater than 90. The strict definition of hypertension has not changed with this report. There is a new subcategory of normal blood pressure known as "prehypertension" that we will discuss later in the module, however this new category did not lower the definition of hypertension.
Question 2:

How many elevated blood pressure measurements do you have to get from your patient, Mary Johnson, before you can diagnose her with “hypertension”?(Choose the one best answer)

  1. One elevated measurement, on any arm, at one visit.
  2. At least two elevated measurements, one in each arm, on one visit.
  3. At least two elevated measurements, one in each arm, should be made on 2 or more visits.
  4. At least two elevated measurements, on any arm, should be made on 2 or more visits.
  5. At least two elevated measurements, one in each arm, should be made on 3 or more visits.
Show answer >>
The correct answer is C. As per JNC 7 standards, at least two elevated measurements, one in each arm, should be made on 2 or more visits. Diagnosing a patient with hypertension should not be made when the patient is acutely ill (example – a patient in pain). The reason you take a measurement in each arm is to evaluate whether an adult patient actually has "coarctation of the aorta" or another aortic anomaly, where the pressure will be high in the right arm but low in the left arm

Proper Office Blood Pressure Measurement Techniques

Proper BP Technique   Audio of Proper Office BP Techniques (Running Time 1:29)

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One of the most common causes of misdiagnosis or improper management decisions regarding hypertension involves blood pressure measurement errors. These errors are made by staff, nurses, medical students, and physicians alike. Proper office techniques include having the patient seated quietly for 5 minutes in a chair (not on an exam table), feet on the floor, and arm supported at heart level. Use an auscultatory method with a properly calibrated and validated instrument. Incidentally, mercury syphgnomometer have been validated but are no longer used in clinical care because mercury is considered a toxic substance. One appropriate alternative is an aneroid device which uses a metal spring to measure blood pressure. These have a round compass-like face that is attached to a cuff and accompanied by a stethoscope, and are common in physicians' offices. Another alternative is an electronic device that measure pressure by converting the readings into measurable electronic waves. Most importantly, an appropriate-sized cuff should be used to ensure accuracy (the bladder should wrap around 80% of the arm circumference). If the cuff is too small, the blood pressure reading may be erroneously high. With increasing prevalence of obesity today, most adults no longer fit "adult" blood pressure cuffs and may require an "extra large" or "thigh" cuff to go around their arms.

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