Coronary Artery Calcium Score may serve as guide for the treatment of Hypertension

A study by McEvoy et al published in Circulation determined that computed tomography of the heart used to detect coronary artery calcium levels (CAC) can assist in the creation of treatment plans for patients with high blood pressure.

Their study tracked 3,733 people whose mean age was 65 years and had a systolic blood pressure between 120 and 179 mm Hg.  During the study period that tracked the enrolled patients for over 10 years 642 events were detected. 

The researchers found that patients with calcium scores of zero who were at high risk of arteriosclerotic heart disease (ASCVD) their incidence of a heart attack or stroke was low. While patients with systolic blood pressure lower than 140 mm Hg and a low risk of heart disease that had a CAC of more than 100 their incidence of a heart attack or stroke was higher.

The authors concluded that CAC scoring and assessment of arteriosclerotic vascular disease may guide in the determination of selecting as a goal to achieve the traditional 140 mm Hg or a lower systolic blood pressure such as 120 mm Hg particularly among patients with an estimated ASCVD risk of 5-15% and prehypertension or mild hypertension.

Hypertension initiative

 The U.S. Department of Health and Human Services announced an initiative the Million Hearts®2014 Hypertension ControlChallenge that aims to prevent 

1 million heart attacks and strokes over five years.

Some of its key blood pressure control tips include:

·       Using a standardized checklist approach to measure blood pressure. 

·       Implementing a self-measured blood pressure program- (sometimes called     home blood pressure monitoring).  

·        Common problems that can account for inaccurate and higher blood      pressure measurements are:

A full bladder                     10-15 mmHg

An unsupported back           5-10 mmHg

Unsupported feet                 5-10 mmHg

Crossed legs                         2-8 mmHg

Cuff over clothing              10-40 mmHg
Wrong size cuff                    high or low

Unsupported arm                   10 mmHg

A conversation                  10-15 mmHg 

Three questions doctors, nurses and other health care provides should ask patients when measuring their blood pressure are:

•  “Were you rushing to get here or were you physically active right before this appointment?”  Patients should have time to rest before their blood pressure measurement and they should be sitting quietly.
• “Have you been taking your medication?” Although it self-evident it’s important to make sure if patients take their medication as it was prescribed.
• “What’s your diet and physical activity regimen like?” If a patient doesn’t eat a healthy diet or abstains from physical activity, find out why. 

The American Medical Association and Johns Hopkins School of Medicine call for physicians and care teams to measure accurately, act rapidly and partner with patients to promote patient self-management.

References: Pickering et al Circulation 2005, O’Brien et al Blood Press Mon 2002