Dear Student Doctors,
FEBRUARY 2014 IS:
Hypertension Awareness Month
- The CDC estimates that over 67 million Americans have high blood pressure, yet only 16 million are aware of their condition or receiving treatment
- Hypertension is often referred to as a silent disease because of its low rate of diagnosis and the wide array of complications it may cause
- Hypertension accounts for 54% of all strokes, and 47% of ischemic heart disease, globally, and also contributes to heart failure, renal disease, and many other other conditions
- 90-95% of hypertension is "idiopathic" and has no known medical cause
Hypertension at HIPHOP Promise Clinic
Based on our 2011 demographic survey, nearly 2/3 of patients seen at Promise Clinic have hypertension, making it by far the most common condition treated in clinic. Hence, most teams should be familiar with the condition. Many PC patients also have Diabetes or other conditions that significantly increase their risk of complications from hypertension.
Evidence-based Thyroid Disease Care
- Screening: ALL patients in Promise Clinic should have a student assess their blood pressure at EVERY visit!
- Diagnosis: Diagnosis of hypertension cannot be concluded at a single visit. To properly diagnose hypertension, a patient's blood pressure must be measured as greater than 140/90 after 5 minutes rest (sitting down) on three different occasions within 1 month.
- Be mindful of hypertensive urgency (BP > 180/120) and hypertensive emergency (BP > 180/120 plus symptoms / evidence of acute organ damage), requiring immediate treatment
- Upon diagnosis, all patients with hypertension should receive a one-time fasting plasma glucose and a cholesterol screen (non-fasting), and any necessary follow-up to these two tests.
- Patients should be treated to a goal blood pressure below 140/90. Patients with known history of diabetes or certain kidney problems may benefit from a goal below 130/80.
- First-line therapy for all patients with systolic BP between 140 and 160 is lifestyle modification! Modifications include smoking cessation/reduction, weight management, diet, exercise, and decreased alcohol consumption (practice your motivational interviewing!). IF lifestyle modification does not work or systolic BP > 160, the following medical therapy is indicated:
- In patients without cardiovascular disease (CVD), medication should begin with either a low-dose diuretic OR an ACE inhibitor. If ineffective, add the other medication as 2nd line drug. If still ineffective, calcium channel blockers are 3rd line.
- In patients with CVD, 1st line therapy is an ACE inhibitor OR beta-blocker, 2nd line is adding the other, and 3rd line is adding a diuretic.
- Always remember:
- Consider medication price when starting/changing hypertension medications!!!
- Anti-hypertensive medications work at different rates. Consider the duration to effect prior to any medication changes.
- Consider additional labs / follow-up if patient's history/physical suggests a medical cause to their hypertension - don't miss the 5-10%...
If you need help solving a problem please reach out to senior members of your team, student managers, schedulers or the appropriate steering committee/operations committee member as soon as possible.
PCM: If you are having trouble completing PCM visit requirements, please contact Afua Takyi (firstname.lastname@example.org) at least one week in advance so she can arrange for you to temporarily join a team. A physician preceptor must sign off on your off-site activity attendance record at each appointment if you are receiving PCM credit. A senior member of you student team may complete the end of year evaluation.