HYPERTENSION ENCOUNTER FORM - Michigan …

1 HYPERTENSION ENCOUNTER form - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -continued Patient s name: _____ Age: _____ Weight: _____ Height: _____ BMI (over): _____HISTORY OF PRESENT ILLNESS_____ Loud snoring, obesity, gasping and daytime sleepiness (sleep apnea) Headache, sweating and palpitations (pheochromocytoma)Major risk factors (check if present)Target-organ damage (check if present) HYPERTENSION Tobacco use Obesity (BMI 30 kg per m2) Physical inactivity Dyslipidemia Diabetes mellitus Microalbuminuria or glomerular filtration rate < 60 mL per minute Age > 55 years (men) or > 65 years (women) Family history of premature cardiovascular disease (men < 55 years or women < 65 years) Left ventricular hypertrophy or chronic heart failure Angina, prior myocardial infarction, revascularization Stroke or transient ischemic attack Chronic kidney disease Peripheral arterial disease Retinopathy Diagnosis confirmed by.

2 Serial measurements at home Serial measurements in the office Ambulatory blood pressure monitoring Bilateral blood pressure measure: Systolic blood pressure (SBP)/diastolic blood pressure (DBP) Right arm: / Left arm: /NormalAbnormalLooking forComment if abnormalOptic fundi Vascular disease_____Auscultate for bruits_____Carotid Vascular disease_____Abdominal Vascular disease_____Femoral Vascular disease_____Thyroid gland Thyroid disease_____Heart Valve disease, cardiomegaly_____Lungs Heart failure_____Abdomen_____Aortic pulsation Aneurysm_____Mass Aneurysm_____Lower extremity edema_____Edema Heart failure_____Pulses Vascular disease_____Leg blood pressure Vascular disease_____Purple striae/moon facies Cushing s disease_____Neurologic examination Vascular disease_____LABORATORY EVALUATIONN ormalAbnormalOrderedValueLooking for end-organ damageUrinalysis _____Electrocardiogram _____Looking for causes of secondary hypertensionPotassium _____Creatinine _____Calcium _____Looking for comorbiditiesCholesterol _____Low-density lipoproteins _____High-density lipoproteins _____Triglycerides _____Hematocrit _____Blood glucose _____ASSESSMENT/PLAND iagnosis: Prehypertension (SBP: 120 to 139 mm Hg, or DBP: 80 to 89 mm Hg) Stage 1 HYPERTENSION (SBP: 140 to 159 mm Hg, or DBP.)

3 90 to 99 mm Hg) Stage 2 HYPERTENSION (SBP: 160 mm Hg, or DBP: 100 mm Hg) BP Goal: 140/90 mm Hg 130/80 mm Hg (if patient has diabetes or chronic kidney disease) Other: Lifestyle recommendations: Salt reduction to 2 g daily DASH diet Weight loss Regular exercise Moderation of alcoholDrug therapy:Follow-up:PHYSICIAN S SIGNATURE: _____PHYSICAL EXAMINATIONHYPERTENSION ENCOUNTER form continued- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ENCOUNTER form developed by Mark H. Ebell, MD, MS. Copyright 2004 American Academy of Family Physicians. Physicians may photocopy or adapt for use in their own practices; all other rights reserved. A Tool for Evaluating HYPERTENSION . Ebell MH.

4 Family Practice Management. March 2004:79-81; SUPPORT FOR FURTHER INVESTIGATION Abnormal creatinine or severe HYPERTENSION Consider renovascular disease. Hypokalemia Consider primary aldosteronism. Thyroid abnormality Consider hyperthyroidism. Upper but not lower extremity HYPERTENSION Consider coarctation of aorta. Bruit Consider cerebrovascular disease. Headache, sweating and palpitations Consider pheochromocytoma. Cushingoid body habitus Consider Cushing s disease. Persistent or severe elevation Consider medications, illicit drug use and excessive alcohol use. Loud snoring, obesity, gasping and daytime sleepiness Consider sleep apnea. Diagnosis confirmed by: Serial measurements at home Serial measurements in the office Ambulatory blood pressure monitoringDECISION SUPPORT FOR SELECTION OF A DRUG CLASSI ndicationsRecommendations Stage 1: No compelling indications (as listed below)Diuretic for most.

5 May consider ACEI, ARB, BB, CCB or combination. Stage 2: No compelling indications (as listed below)Two-drug combination for most. Usually thiazide diuretic plus ACEI or ARB, BB or indications for certain antihypertensive drugs Stable anginaBB (alternate is long acting CCB) Acute coronary syndrome or unstable anginaBB or ACEI Postmyocardial infarctionACEI, BB or AldoAnt Heart failure asymptomatic with left ventricular dysfunctionACEI or BB Heart failure symptomatic left ventricular dysfunctionACEI, BB, ARB, AldoAnt or loop diuretic High coronary artery disease riskDiuretic, BB, ACEI or CCB DiabetesACEI, ARB, diuretic, BB or CCB Chronic kidney diseaseACEI or ARB Recurrent stroke preventionDiuretic or ACEIACEI = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; BB = beta blocker; CCB = calcium channel blocker.

6 AldoAnt = aldosterone DRUGSD iuretics Chlorthalidone, to 25 mg once daily Hydrochlorothiazide (HCTZ), to 50 mg once daily Triamterene/HCTZ, to 75 mg/25 to 50 mg once dailyAldosterone blockers Spironolactone, 25 to 50 mg once dailyAngiotensin-converting enzyme inhibitors Lisinopril, 10 to 40 mg once daily Enalapril, to 40 mg daily, divided doses once to twice dailyBeta blockers Metoprolol, 50 to 100 mg once to twice daily Atenolol, 25 to 100 mg once dailyBODY MASS INDEX CALCULATORH eightWeightInches58596061626364656667686 97071727374 Lbkgcm1471501521551571601631651681701731 7517818018318518890411918181716161515151 4141313131212121004521202019181817171616 1515141414131311050232222212020191818171 7161615151514120552524232322212120191918 1817171616151305927262525242322222120201 9191818171714064292827272625242323222121 2020191918150683130292827272625242423222 2212020191607334323130292828272625242423 2222212117077363433323130292827272625242 4232222180823836353433323130292827272625 2424231908640383736353433323130292827272 6252420091424039383736343332313030292827 2626210954443414038373635343332313029292 8272201004645434240393837363534333231302 9282301054847454442414038373635343332313 0302401095049474544434140393837363534333 2312501145251494746444342403938373635343 3322601185453514948464543424140383736353 4332701235755535149484645444241403938373 6352801275957555351504847454443414039383 7362901326159575553515048474644434241393 837 BMI 24: Normal weight; BMI 25 to 29: Overweight; BMI 30 to 39: Obese; BMI 40 Extreme obesity.