Medicine

A 60-year-old man is found to have elevated blood pressure during a routine checkup.

He has no symptoms, and physical examination is unremarkable. ECG, CBC, electrolytes, renal function tests, and urine analysis are normal. Which of the following is the most appropriate next option in management?

  1. A Request echocardiogram
  2. B Start antihypertensive medication
  3. C Perform ambulatory blood pressure measurement الإجابة الصحيحة
  4. D Repeat office blood pressure measurement in 3 months

الشرح

Core Concept: Office blood pressure measurements can be falsely elevated due to 'white-coat hypertension'. Current guidelines recommend out-of-office BP measurements to confirm the diagnosis of hypertension before initiating lifelong pharmacotherapy.

Clinical Presentation:

  • Asymptomatic elevated BP in the clinic.

Diagnosis:

  • First-line diagnostic plan: Repeated office BP measurements.
  • Gold standard: Ambulatory Blood Pressure Monitoring (ABPM) or Home Blood Pressure Monitoring (HBPM) to confirm sustained hypertension and rule out white-coat effect.

Management:

  • Acute management: Order ABPM.
  • Gold standard long-term management: If ABPM confirms hypertension, initiate lifestyle modifications and antihypertensive medications based on the patient's overall cardiovascular risk profile.

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