Failure to Diagnose & Delay in Treatment of Hypertension (High Blood Pressure, HTN)

Evaluate breaches in the standard of care in cases where there has been a Failure to Diagnose & Delay in Treatment of Hypertension (High Blood Pressure, HTN)

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following did the patient present? (Choose all that apply)
    Headache
    Visual disturbance
    Chest pain
    Shortness of breath
    Other symptoms
    Asymptomatic
    Signs/Symptoms not elicited
    Answer unknown
    Why is this important?
    Individuals with hypertension are usually asymptomatic, therefore it is referred to as the “silent killer”.
    (2010) 38 EMEDIC 8 403-408

  • Was an accurate measurement of the patient’s blood pressure obtained? Why is this important?
    Answer this question
    
Proper measurement and interpretation of the patient’s blood pressure is essential in the diagnosis and management of hypertension.

    (2010) 38 EMEDIC 8 403-408 



  • Was a detailed medication history obtained? Why is this important?
    Answer this question
    
A thorough history of all the medications the patient is taking is essential since many prescription medications may affect the blood pressure.

    (2010) 38 EMEDIC 8 403-408 



  • Was a thorough medical history obtained? Why is this important?
    Answer this question
    
A family history of hypertension and previous pregnancy-related hypertension are predisposing factors.

    (2010) 38 EMEDIC 8 403-408 



  • Were the risk factors for increased cardiovascular disease obtained? Why is this important?
    Answer this question
    
A concurrent history of diabetes mellitus, hyperlipidemia and/or smoking raises a patient’s cardiovascular risk.

    (2010) 38 EMEDIC 8 403-408 



  • Was a physical examination performed? Why is this important?
    Answer this question
    
The physical examination may be normal apart from elevated blood pressure readings.

    (2010) 38 EMEDIC 8 403-408 



  • Which of the following laboratory investigations were done? (Choose all that apply) Why is this important?
    Answer this question
    
Minimum routine investigations in the initial evaluation of a patient with hypertension must include; urinalysis for protein and blood, serum electrolytes, serum creatinine, an estimated glomerular filtration rate (eGFR),fasting blood glucose and lipid profile.

    (2007) 32 ECPCAR 4 201-259 



  • Which of the following diagnostic studies were performed to evaluate a secondary cause for hypertension? (Choose all that apply) Why is this important?
    Answer this question
    
If secondary causes of hypertension are suspected, other investigations are needed.

    (2010) 38 EMEDIC 8 403-408 



  • Was the patient referred to a specialist? Why is this important?
    Answer this question
    
Referral to a specialist is advised when a secondary cause of the hypertension is identified.

    (2008) 35 EPCCOP 3 489-500 



  • With what stage hypertension was the patient diagnosed? Why is this important?
    Answer this question
    
It is important to assess and accurately stage newly confirmed hypertension as treatment modalities will vary between stages.

    (2007) 32 ECPCAR 4 201-259 



  • Which of the following treatment options were initiated? Why is this important?
    Answer this question
    
Lifestyle modifications (non pharmacologic therapy) must be advised to all patients with blood pressures between 120-139/80-89 mmHg (pre-hypertension) and also to all those with sustained hypertension.

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  • Which of the following drugs were administered? Why is this important?
    Answer this question
    
Drug Therapy is dictated by the patient's overall cardiovascular risk and the presence or absence of co-morbid conditions.

    Click here for additional information at ClinicalKey.com 



  • Was health education provided concerning the newly diagnosed hypertension? Why is this important?
    Answer this question
    
To achieve success with anti-hypertensive therapy, intense patient education is required.

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  • Did the clinician advise regular follow-up visits? Why is this important?
    Answer this question
    
Once anti-hypertensive drug therapy is initiated, patients must return for follow-up blood pressure evaluation and medication adjustments on a regular basis.

    (2007) 32 ECPCAR 4 201-259 



  • Which of the following treatment options were initiated in the patient with high blood pressure during follow-up? Why is this important?
    Answer this question
    
If blood pressure goals are not met, the clinician has three options for subsequent therapy; add a second drug from another class, substitute an agent from another class, or increase the dose of the initial drug.

    (2007) 32 ECPCAR 4 201-259 



  • Was the patient experiencing a hypertensive crisis referred to the hospital? Why is this important?
    Answer this question
    
Hypertensive emergencies are best cared for in a hospital (typically in an intensive care unit).

    (2007) 32 ECPCAR 4 201-259