高血压临床个案课件.pptxVIP

Hypertension Clinical case scenarios for primary care Implementing NICE guidance August 2011 NICE clinical guideline 127 Five clinical case scenarios, including: • presentation • medical history • examination The clinical decisions surrounding diagnosis and management will then be examined What this presentation covers Definitions Stage 1 hypertension: • Clinic blood pressure (BP) is 140/90 mmHg or higher and • ABPM or HBPM average is 135/85 mmHg or higher. Stage 2 hypertension: • Clinic BP 160/100 mmHg is or higher and • ABPM or HBPM daytime average is 150/95 mmHg or higher. Severe hypertension: • Clinic BP is 180 mmHg or higher or • Clinic diastolic BP is 110 mmHg or higher. White-coat effect: • A discrepancy of more than 20/10 mmHg between clinic and average daytime ABPM or average HBPM blood pressure measurements at the time of diagnosis Return to Derek Return to Mary Return to Danny Return to Doris Case scenario 1 : Mary Presentation 38 year old, attending for routine appointment about her contraception, for which she uses a diaphragm. Medical history From her records you notice that Mary’s blood pressure has increased since her last check twelve months ago. She does not smoke, drinks 10-12 units of alcohol a week and has no notable medical history. On examination Mary’s first clinic blood pressure measurement is 158/94 mmHg. Her heart rate is 72 beats per minute and regular You are considering a diagnosis of hypertension and therefore take another reading in Mary’s other arm. There is no notable difference between readings. Next steps for diagnosis Question 1.1 What would you do next? Question 1.2 The third reading is 149/93 mmHg. You suspect hypertension – what would you do next? Answer 1.1 You would take Mary’s blood pressure a third time during the consultation. Case scenario 1 : Mary Case scenario 1 : Mary Answer 1.2 Organise for Mary to receive ABPM through your GP practice. If you are responsible for