An 80-year-old man with benign prostatic hyperplasia presents for a follow-up appointment with his urologist. Triage BPs are 155/95 mm Hg and 153/97 mm Hg.
He is sent for laboratory testing and then is taken to the examination room. His clinician enters the room 45 min after he arrived in triage and repeats his BP measurements, obtaining 135/82 mm Hg and 133/80 mm Hg.
The triage BP elevations are likely related to anxiety regarding his anticipated laboratory testing.
Show Answer
The correct answer is: Fiction
Although situational and procedural anxiety can lead to intermittent BP elevation (most commonly seen with "white coat" hypertension), there are other potential causes of his initial elevation.
A full bladder, which is not uncommon in the setting of benign prostatic hyperplasia, can raise the systolic blood pressure (SBP) reading by as much as 33 mm Hg and the diastolic blood pressure (DBP) reading by as much as 18 mm Hg.1 Providing a urine specimen for this patient's laboratory assessment, and thus emptying his bladder, could explain the substantial improvement in BP on repeat measurement.
Caffeinated or alcoholic beverage ingestion or exposure to nicotine within 30 min of a BP measurement can also raise BP substantially (up to 14 mm Hg SBP and 13 mm Hg DBP for caffeinated beverages; up to 25 mm Hg SBP and 18 mm Hg DBP for alcoholic beverages and nicotine). The time between triage, laboratory assessment, and repeat BP measurement could therefore also explain the lower BP obtained on repeat measurement.1
This patient case quiz is part of the larger Overcoming Challenges in Hypertension Management grant. Educational grant support is provided by Medtronic. To visit the Overcoming Challenges in Hypertension Management grant page and access additional educational activities on this topic, click here.
References
Muntner P, Einhorn PT, Cushman WC, et al.; 2017 National Heart, Lung, and Blood Institute Working Group. Blood pressure assessment in adults in clinical practice and clinic-based research: JACC scientific expert panel. J Am Coll Cardiol 2019;73:317-35.
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