Course 03: Cardiovascular, Vascular and Hematology
Lesson 2 of 12. Read the diagnostic framework and case, then complete the 10-question practice set. All material is original educational content; high-risk presentations require emergency referral.
Measurement and diagnosis
- Use an appropriately sized cuff and validated automated device, seated rest, supported arm and consistent standardized technique.
- Hypertension Canada 2025 recommends a standardized BP threshold of at least 130/80 mm Hg; confirm with out-of-office readings to detect white-coat or masked hypertension.
- Differentiate diagnosis threshold, medication initiation threshold and individualized treatment target; these are not identical.
- Consider secondary causes when onset is young, severe or resistant: renal disease, sleep apnea, primary aldosteronism, medications and endocrine causes.
Treatment and target
- Promote sodium reduction, regular activity, weight optimization, sleep health, smoking cessation and moderation of alcohol.
- Guideline pharmacotherapy is generally initiated at BP at least 140/90 mm Hg or at SBP 130–139 in high cardiovascular-risk adults, after clinical assessment.
- Aim for a tolerated systolic BP below 130 mm Hg as recommended in the 2025 primary-care guideline, with individual adjustments for frailty, orthostasis and adverse effects.
- Common first-line drug classes include thiazide/thiazide-like diuretics, ACE inhibitors/ARBs and dihydropyridine calcium-channel blockers; monitor electrolytes and renal function when relevant.
- Hypertensive emergency requires elevated BP with acute target-organ damage; severe BP alone without injury does not automatically define an emergency.
Lipids and risk assessment
- Review lipids, diabetes, smoking, renal function, family history, BP and existing atherosclerotic cardiovascular disease to estimate absolute risk.
- Document indications for statin therapy in established ASCVD and high-risk primary prevention; intensification depends on response and guideline thresholds.
- Discuss myalgias, adherence, pregnancy considerations, potential drug interactions and follow-up lipid measurements.
- Coronary artery calcium may refine risk in selected uncertain primary-prevention decisions; a zero score does not eliminate risk in all people.
Secondary prevention
- After atherosclerotic events prioritize evidence-based statins, smoking cessation, exercise/cardiac rehab, glucose/BP optimization and appropriate antithrombotic plans.
- Recognize that aspirin for primary prevention is not routinely indicated and can cause bleeding; review individualized benefits and harms.
- Assess drug interactions and possible blood-pressure or arrhythmia effects of stimulants, NSAIDs, decongestants, licorice and other complementary products.
Communication and follow-up
- Use home BP logs with date/time readings and a jointly agreed reassessment schedule; verify adherence before labeling resistant hypertension.
- Explain absolute risk reduction and the difference between treating a risk factor and treating a symptom.
- Build a realistic plan incorporating cost, access, culture, health literacy and personal preferences.
Applied clinical case
A 55-year-old with repeated clinic BP 151/92 mm Hg has no symptoms. Home monitoring averages 148/90; history includes smoking and diabetes.
Show model clinical reasoning and disposition
This is confirmed hypertension needing timely clinician-directed treatment and global CVD risk reduction; screen for target-organ damage, discuss medication plus lifestyle, and follow BP/labs.
Clinical self-check
- Is this a hypertensive emergency?
- How should home readings affect diagnosis?
- Which other risk factors should be treated?
Guidelines and further learning
- Hypertension Canada — 2025 recommendations (external)
- Canadian Cardiovascular Society — Guidelines Library (external)