October

Manual office blood pressure (BP) measurement can be used to diagnose hypertension when readings from three separate visits are averaged and the systolic blood pressure (SBP) is equal to or greater than 160 mm Hg, or the dia­stolic blood pressure (DBP) is equal to or greater than 100 mm Hg. Hypertension can also be diagnosed when readings from five visits are averaged and the SBP is equal to or greater than 140 mm Hg, or the DBP is equal to or greater than 90 mm Hg.[1] 

There is a direct and continuous relationship between blood pressure (BP) and the development of cardiovascular disease. A meta-analysis of 1 million adults with no previous vascular disease from 61 prospective observational studies found that for persons in middle and old age, blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mm Hg.[1] 

Resistant hypertension is de­fined as blood pressure that remains above goal in spite of the concurrent use of three antihypertensive agents of different classes, including one diuretic, prescribed at optimal doses.[1] Some investigators estimate that 20% to 30% of patients with high blood pressure appear to  have resistant hypertension.

As physicians, we are driven to relieve our patients’ pain. To do so, we first attempt to de­termine the cause of their pain. With disabling back pain, the temptation is to order an MRI or CT scan. But is this always a good idea?

Effectiveness of imaging
A significant portion of the general population will experience at least one episode of nonspecific low back pain during their lifetime. However, the presence of back pain correlates poorly with abnormalities found on imaging.

References