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Our first four lectures will focus on the nuts and bolts of mental math: addition, subtraction, multiplication, and division

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Once we have mastery of the basics of mental math, we will branch out in interesting directions. Lecture 5 offers techniques for easily finding approximate answers when we don’t need complete accuracy. Lecture 6 is devoted to pencil-and-paper mathematics but done in ways that are seldom taught in school; we’ll see that we can simply write down the answer to a multiplication, division, or square root problem without any intermediate results. This lecture also shows some interesting ways to verify an answer’s correctness. In Lecture 7, we go beyond the basics to explore advanced multiplication techniques that allow many large multiplication problems to be dramatically simplified.

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In Lecture 8, we explore long division, short division, and Vedic division, a fascinating technique that can be used to generate answers faster than any method you may have seen before. Lecture 9 will teach you how to improve your memory for numbers using a phonetic code. Applying this code allows us to perform even larger mental calculations, but it can also be used for memorizing dates, phone numbers, and your favorite mathematical constants. Speaking of dates, one of my favorite feats of mental calculation is being able to determine the day of the week of any date in history. This is actually a very useful skill to possess. It’s not every day that someone asks you for the square root of a number, but you probably encounter dates every day of your life, and it is quite convenient to be able to figure out days of the week. You will learn how to do this in Lecture 10. In Lecture 11, we venture into the world of advanced multiplication; here, we’ll see how to square 3- and 4-digit numbers, find approximate cubes of 2-digit numbers, and multiply 2- and 3-digit numbers together. In our final lecture, you will learn how to do enormous calculations, such as multiplying two 5-digit numbers, and discuss the techniques used by other world- record lightning calculators.

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There’s also a simple trick to multiplying by 9s: The multiples of 9 have the property that their digits add up to 9 (9 × 2 = 18 and 1 + 8 = 9). Also, the first digit of the answer when multiplying by 9 is 1 less than the multiplier (e.g., 9 × 3 = 27 begins with 2).

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The product of 11 and any 2-digit number begins and ends with the two digits of the multiplier; the number in the middle is the sum of the original two digits. Example: 23 × 11 => 2 + 3 = 5; answer: 253. For a multiplier whose digits sum to a number greater than 9, you have to carry. Example: 85 × 11 => 8 + 5 = 13; carry the 1 from 13 to the 8; answer: 935.

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The product of 11 and any 3-digit number also begins and ends with the ¿ rst and last digits of the multiplier, although the ¿ rst digit can change from carries. In the middle, insert the result of adding the ¿ rst and second digits and the second and third digits. Example: 314 × 11 ĺ 3 + 1 = 4 and 1 + 4 = 5; answer: 3454.

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To square a 2-digit number that ends in 5, multiply the first digit in the number by the next higher digit, then attach 25 at the end. Example: 35 * 2 => 3 × 4 = 12; answer: 1225. For 3-digit numbers, multiply the first two numbers together by the next higher number, then attach 25. Example: 305 2 ĺ 30 × 31 = 930; answer: 93,025.

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To multiply two 2-digit numbers that have the same ¿ rst digits and last digits that sum to 10, multiply the ¿ rst digit by the next higher digit, then attach the product of the last digits in the original two numbers. Example: 84 × 86 ĺ 8 × 9 = 72 and 4 × 6 = 24; answer: 7224.

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To multiply a number between 10 and 20 by a 1-digit number, multiply the 1-digit number by 10, then multiply it by the second digit in the 2-digit number, and add the products. Example: 13 × 6 ĺ (6 × 10) + (6 × 3) = 60 + 18; answer: 78.

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To multiply two numbers that are both between 10 and 20, add the first number and the last digit of the second number, multiply the result by 10, then add that result to the product of the last digits in both numbers of the original problem. Example: 13 × 14 ĺ 13 + 4 = 17, 17 × 10 = 170, 3 × 4 = 12, 170 + 12 = 182; answer: 182.

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_\bl1 'l;bayda rncntions t\VO reports that explain the causes of the quarrel bct\vccn Jarir and al-Farazdaq. _\ccording to the first, jealousy led the latter to cornposc invective poetry against Jar .. ir. This report tells about a good relationship bct\vccn the t\VO poets. On his \Vay bttck frorn a pilgrirnagc, al-Farazdaq arrived at Lughii~, \vhich \Vas perhaps a source of \vatcr or a rnountain in al- '{a1nii1na, Tl \vhcrc Jar1r and his farnily lived. Jarir visited hirn, apologized for his attack on al-Ba 'Ith, and recites sornc of his love and invective verses. _\l-1\a\viir, al-Farazdaq's \vifc, listened to Jarir and adrnircd his pocrns. _\l-Farazdaq, \vhosc jealousy \Vt4S aroused by her co1npli1ncnts, cornposcd sornc invective verses against Jarir. _\bli 'l;bayda docs not rncntion these verses nor docs he rncntion any countcr- vcrscs by Jarir in \vhich he condcrnns aJ-Farazdtt(l for his invective. It sccrns that either the verses of al-Farazdaq did not reach Jarir, or, if they did, Jarir decided for sornc reason not to condcrnn al-Farazdaq. _:\._ third possibility rnay be that Jarir really knc\v about al-Farazdaq's verses, and that he ttctually cornposcd verses refuting thcrn, but these \Vere lost.

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AJ-Farazdaq continued his journey to al-Btk?ra 75 , and there he de- cided not to co1nposc invective poetry against :0.-'Iusli1ns again. He shttck- lcd his legs and took an oath not to rclct4SC his shackles before learning the Qur)iin by heart. 70 _:\._ delegation of sornc \VOincn frorn his clan, :V'Iujiishi\ 77 visited hirn. They reproached hirn for \vhat he had done to hin1sclf, told hirn about the harsh invective pocn1s that J arlr corn posed against thcrn, urged hirn to release his shackles and begin cornposing invective poetry against Jar1r. AJ-Farazdaq bo\vcd to this pressure, re- leased hin1sclf, and stopped learning the Qur)iin in order to cornposc poetry [l\JF 31]. 78 This \Vt4S the second, and n1ore serious, reason that obliged al-Farazdaq to enter the naqii/ir/, contest against Jarlr.

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#english #game #strauss
"If you can make a girl envy you," Mystery told the students, "you can make a girl sleep with you." Two principles were at work. First, he was generating social proof by earning the attention and approval of the club staff. And, second, he was pawning—in other words, he was using one group to work his way into an- other, less approachable group nearby.

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#english #game #strauss
I'd heard it all before from dozens of guys. And I'd heard just as many intelligent women say, "That wouldn't work on me," when I told them about the community. Yet minutes or hours later, I'd see them exchanging phone numbers—or saliva—with one of the boys. The smarter a girl is, the better it works. Party girls with attention deficit disorder generally don't stick around to hear the routines. A more perceptive, worldly, or educated girl will listen and think, and soon find herself ensnared.

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#english #game #strauss
I ran my hands beneath her hair and slowly dragged my fingernails up- ward along her scalp. A shiver of pleasure ran through her body. Our lips met, our tongues met, our chests met.

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#english #game #strauss
to inspire her to take the risk of saying yes, I would have to grow some balls and be willing to leave my comfort zone. And it was by watching Mystery win over Natalija that I learned this lesson. "I just got a haircut," he told her as they left the cafe. "I have itchy hairs on my neck. I want to take a bath. Come wash me." Natalija, predictably, said that seemed like a bad idea. "Oh, okay," he told her. "I gotta get going, because I need to take a bath. Bye." As he walked away, her face fell. The thought that she might never see him again seemed to flash through her mind. This is what Mystery calls a false takeaway. He wasn't really leaving; he was just letting her think he was. Mystery took five steps—counting as he went—then turned around and said, "I've been living in a shitty apartment for the past week. I'm going to get a hotel room right there and take a bath." He pointed to the Hotel Moskva down the street. "You can come with me or just get an e-mail from me in two weeks when I return to Canada." Natalija hesitated for a moment, then followed him. And that's when I realized the mistake I'd been making my whole life: to get a woman, you have to be willing to risk losing her.

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Jeśli nie uda się dogadać z Brukselą, chcą głosować jeszcze raz.

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Brytyjczycy chcą drugiego referendum, jeśli negocjacje z UE skończą się fiaskiem
lipca (Fot. Matt Dunham / AP Photo) 29 Więcej na ten temat: Wielka Brytania, brexit A większość obywateli Królestwa uważa, że rozmowy idą źle, zaś cały proces brexitowy to jeden wielki bałagan. <span>Jeśli nie uda się dogadać z Brukselą, chcą głosować jeszcze raz. Czytasz ten artykuł, bo jesteś prenumeratorem Wyborczej. Dziękujemy! „Czy ostateczną decyzję powinni podjąć posłowie, głosując w parlamencie, czy społeczeństwo – w referendum?” – brzmia




#airplanes #aviation #wiki
Many stories from antiquity involve flight, such as the Greek legend of Icarus and Daedalus, and the Vimana in ancient Indian epics.

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Airplane - Wikipedia
se aircraft. History Main articles: Aviation history and First flying machine Le Bris and his glider, Albatros II, photographed by Nadar, 1868 Otto Lilienthal in mid-flight, c. 1895 Antecedents <span>Many stories from antiquity involve flight, such as the Greek legend of Icarus and Daedalus, and the Vimana in ancient Indian epics. Around 400 BC in Greece, Archytas was reputed to have designed and built the first artificial, self-propelled flying device, a bird-shaped model propelled by a jet of what was probably




#blood #goal #pressure
treatment of hypertension is the most common reason for office visits of nonpregnant adults to clinicians in the United States and for use of prescription drugs [1-3].

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UpToDate
is complete. Literature review current through: Jul 2018. | This topic last updated: May 18, 2018. INTRODUCTION — The prevalence of hypertension is high in the United States and worldwide, and <span>treatment of hypertension is the most common reason for office visits of nonpregnant adults to clinicians in the United States and for use of prescription drugs [1-3]. An overview of initial management (ie, when to initiate antihypertensive drug therapy and with how many agents) and goal blood pressure in adults with hypertension is discussed in this




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#blood #goal #pressure
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treatment of hypertension is the most common reason for [...] of nonpregnant adults to clinicians in the United States and for use of prescription drugs [1-3].
Answer
office visits


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treatment of hypertension is the most common reason for office visits of nonpregnant adults to clinicians in the United States and for use of prescription drugs [1-3 ].

Original toplevel document

UpToDate
is complete. Literature review current through: Jul 2018. | This topic last updated: May 18, 2018. INTRODUCTION — The prevalence of hypertension is high in the United States and worldwide, and <span>treatment of hypertension is the most common reason for office visits of nonpregnant adults to clinicians in the United States and for use of prescription drugs [1-3]. An overview of initial management (ie, when to initiate antihypertensive drug therapy and with how many agents) and goal blood pressure in adults with hypertension is discussed in this







Flashcard 3144058539276

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#blood #goal #pressure
Question
treatment of hypertension is the most common reason for office visits of nonpregnant adults to clinicians in the United States and for use of [...] [1-3].
Answer
prescription drugs


statusnot learnedmeasured difficulty37% [default]last interval [days]               
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treatment of hypertension is the most common reason for office visits of nonpregnant adults to clinicians in the United States and for use of prescription drugs [1-3 ].

Original toplevel document

UpToDate
is complete. Literature review current through: Jul 2018. | This topic last updated: May 18, 2018. INTRODUCTION — The prevalence of hypertension is high in the United States and worldwide, and <span>treatment of hypertension is the most common reason for office visits of nonpregnant adults to clinicians in the United States and for use of prescription drugs [1-3]. An overview of initial management (ie, when to initiate antihypertensive drug therapy and with how many agents) and goal blood pressure in adults with hypertension is discussed in this







#blood #goal #pressure
Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured

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UpToDate
pressure in patients with hypertension. These trials, discussed in detail below, form the rationale for our approach to initial management of hypertension and goal blood pressure. In general: ●<span>Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' below): •In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the of




Flashcard 3144061685004

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#blood #goal #pressure
Question
n particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or ambulatory blood pressure monitoring [ABPM]).
Answer
[default - edit me]


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UpToDate
d pressure. In general: ●Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' below): •I<span>n particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or ambulatory blood pressure monitoring [ABPM]). •Overall, routine measurements (ie, manual measurement using a stethoscope or oscillometric device) provide higher readings than other methods of measurement. ●In addition, blood pressu







#blood #goal #pressure

SUMMARY AND RECOMMENDATIONS

● Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above):

• In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]).

• Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM.

● In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above):

• In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.)

However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.)

• In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.)

• In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.)

• In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See

...

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UpToDate
lts (Beyond the Basics)" and "Patient education: High blood pressure treatment in adults (Beyond the Basics)" and "Patient education: High blood pressure, diet, and weight (Beyond the Basics)") <span>SUMMARY AND RECOMMENDATIONS ●Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above): •In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]). •Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM. ●In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above): •In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.) However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.) •In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.) •In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.) •In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Patients with chronic kidney disease' above.) •In most older adults (defined as age 65 years or older), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Older adults' above.) However, we suggest a less aggressive systolic goal blood pressure of 135 to 140 mmHg (routine measurements) or 130 to 135 mmHg (non-routine measurements) in patients 75 years or older with a high burden of comorbidity or a diastolic blood pressure <55 to 60 mmHg and also in older adults with postural hypotension. In older adults with severe frailty, dementia, and/or a limited life expectancy or in patients who are nonambulatory or institutionalized (eg, reside in a skilled nursing facility), we individualize goals and share decision making with the patient, relatives, and caretakers, rather than targeting one of the blood pressure goals mentioned above. •In patients with multiple cardiovascular risk factors (but without established cardiovascular disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (standard, routine measurements) or 120 to 125/<80 mmHg (non-routine measurements) if the estimated 10-year risk of a future cardiovascular event is 15 percent or greater (calculator 1) (Grade 1A); we suggest (a weaker recommendation) these lower goals in patients whose estimated 10-year risk is 10 to 14 percent (Grade 2B). (See 'Patients with multiple cardiovascular risk factors' above.) •In lower-risk patients (ie, those without any of the higher-risk characteristics mentioned above), we recommend a goal blood pressure of 130 to 139/<90 mmHg (using standard, routine clinician office measurements) or 125 to 135/<90 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Goal blood pressure in lower-risk patients' above.) Use of UpToDate is subject to the Subscription and License Agreement. REFERENCES Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline




Flashcard 3144064830732

Tags
#blood #goal #pressure
Question

SUMMARY AND RECOMMENDATIONS

● Our proposed blood pressure targets depend in part upon the [...] by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above):

• In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]).

• Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM.

● In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above):

• In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.)

However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.)

• In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.)

• In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.)

• In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (

...
Answer
method


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SUMMARY AND RECOMMENDATIONS ● Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above): • In particular, blood pressure may be measured in a standard, routine fashion (usual

Original toplevel document

UpToDate
lts (Beyond the Basics)" and "Patient education: High blood pressure treatment in adults (Beyond the Basics)" and "Patient education: High blood pressure, diet, and weight (Beyond the Basics)") <span>SUMMARY AND RECOMMENDATIONS ●Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above): •In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]). •Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM. ●In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above): •In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.) However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.) •In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.) •In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.) •In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Patients with chronic kidney disease' above.) •In most older adults (defined as age 65 years or older), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Older adults' above.) However, we suggest a less aggressive systolic goal blood pressure of 135 to 140 mmHg (routine measurements) or 130 to 135 mmHg (non-routine measurements) in patients 75 years or older with a high burden of comorbidity or a diastolic blood pressure <55 to 60 mmHg and also in older adults with postural hypotension. In older adults with severe frailty, dementia, and/or a limited life expectancy or in patients who are nonambulatory or institutionalized (eg, reside in a skilled nursing facility), we individualize goals and share decision making with the patient, relatives, and caretakers, rather than targeting one of the blood pressure goals mentioned above. •In patients with multiple cardiovascular risk factors (but without established cardiovascular disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (standard, routine measurements) or 120 to 125/<80 mmHg (non-routine measurements) if the estimated 10-year risk of a future cardiovascular event is 15 percent or greater (calculator 1) (Grade 1A); we suggest (a weaker recommendation) these lower goals in patients whose estimated 10-year risk is 10 to 14 percent (Grade 2B). (See 'Patients with multiple cardiovascular risk factors' above.) •In lower-risk patients (ie, those without any of the higher-risk characteristics mentioned above), we recommend a goal blood pressure of 130 to 139/<90 mmHg (using standard, routine clinician office measurements) or 125 to 135/<90 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Goal blood pressure in lower-risk patients' above.) Use of UpToDate is subject to the Subscription and License Agreement. REFERENCES Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline







Flashcard 3144066403596

Tags
#blood #goal #pressure
Question

SUMMARY AND RECOMMENDATIONS

● Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above):

• In particular, blood pressure may be measured in a standard, routine fashion (usually [...]) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]).

• Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM.

● In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above):

• In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.)

However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.)

• In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.)

• In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.)

• In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See

...
Answer
a single, manual measurement in the office with a stethoscope or oscillometric device


statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
ethod by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above): • In particular, blood pressure may be measured in a standard, routine fashion (usually <span>a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure

Original toplevel document

UpToDate
lts (Beyond the Basics)" and "Patient education: High blood pressure treatment in adults (Beyond the Basics)" and "Patient education: High blood pressure, diet, and weight (Beyond the Basics)") <span>SUMMARY AND RECOMMENDATIONS ●Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above): •In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]). •Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM. ●In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above): •In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.) However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.) •In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.) •In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.) •In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Patients with chronic kidney disease' above.) •In most older adults (defined as age 65 years or older), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Older adults' above.) However, we suggest a less aggressive systolic goal blood pressure of 135 to 140 mmHg (routine measurements) or 130 to 135 mmHg (non-routine measurements) in patients 75 years or older with a high burden of comorbidity or a diastolic blood pressure <55 to 60 mmHg and also in older adults with postural hypotension. In older adults with severe frailty, dementia, and/or a limited life expectancy or in patients who are nonambulatory or institutionalized (eg, reside in a skilled nursing facility), we individualize goals and share decision making with the patient, relatives, and caretakers, rather than targeting one of the blood pressure goals mentioned above. •In patients with multiple cardiovascular risk factors (but without established cardiovascular disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (standard, routine measurements) or 120 to 125/<80 mmHg (non-routine measurements) if the estimated 10-year risk of a future cardiovascular event is 15 percent or greater (calculator 1) (Grade 1A); we suggest (a weaker recommendation) these lower goals in patients whose estimated 10-year risk is 10 to 14 percent (Grade 2B). (See 'Patients with multiple cardiovascular risk factors' above.) •In lower-risk patients (ie, those without any of the higher-risk characteristics mentioned above), we recommend a goal blood pressure of 130 to 139/<90 mmHg (using standard, routine clinician office measurements) or 125 to 135/<90 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Goal blood pressure in lower-risk patients' above.) Use of UpToDate is subject to the Subscription and License Agreement. REFERENCES Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline







Flashcard 3144067976460

Tags
#blood #goal #pressure
Question

SUMMARY AND RECOMMENDATIONS

● Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above):

• In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods ([...], home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]).

• Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM.

● In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above):

• In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.)

However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.)

• In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.)

• In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.)

• In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (

...
Answer
automatic oscillometric blood pressure monitoring [AOBPM] performed in the office


statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
r, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (<span>automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]). • Overall, routine/conventional measurements provide higher readings than non-routine measureme

Original toplevel document

UpToDate
lts (Beyond the Basics)" and "Patient education: High blood pressure treatment in adults (Beyond the Basics)" and "Patient education: High blood pressure, diet, and weight (Beyond the Basics)") <span>SUMMARY AND RECOMMENDATIONS ●Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above): •In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]). •Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM. ●In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above): •In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.) However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.) •In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.) •In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.) •In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Patients with chronic kidney disease' above.) •In most older adults (defined as age 65 years or older), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Older adults' above.) However, we suggest a less aggressive systolic goal blood pressure of 135 to 140 mmHg (routine measurements) or 130 to 135 mmHg (non-routine measurements) in patients 75 years or older with a high burden of comorbidity or a diastolic blood pressure <55 to 60 mmHg and also in older adults with postural hypotension. In older adults with severe frailty, dementia, and/or a limited life expectancy or in patients who are nonambulatory or institutionalized (eg, reside in a skilled nursing facility), we individualize goals and share decision making with the patient, relatives, and caretakers, rather than targeting one of the blood pressure goals mentioned above. •In patients with multiple cardiovascular risk factors (but without established cardiovascular disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (standard, routine measurements) or 120 to 125/<80 mmHg (non-routine measurements) if the estimated 10-year risk of a future cardiovascular event is 15 percent or greater (calculator 1) (Grade 1A); we suggest (a weaker recommendation) these lower goals in patients whose estimated 10-year risk is 10 to 14 percent (Grade 2B). (See 'Patients with multiple cardiovascular risk factors' above.) •In lower-risk patients (ie, those without any of the higher-risk characteristics mentioned above), we recommend a goal blood pressure of 130 to 139/<90 mmHg (using standard, routine clinician office measurements) or 125 to 135/<90 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Goal blood pressure in lower-risk patients' above.) Use of UpToDate is subject to the Subscription and License Agreement. REFERENCES Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline







Flashcard 3144069549324

Tags
#blood #goal #pressure
Question

SUMMARY AND RECOMMENDATIONS

● Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above):

• In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, [...] blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]).

• Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM.

● In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above):

• In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.)

However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.)

• In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.)

• In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.)

• In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (

...
Answer
home


statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, <span>home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]). • Overall, routine/conventional measurements provide higher readings than non-routine measurements in

Original toplevel document

UpToDate
lts (Beyond the Basics)" and "Patient education: High blood pressure treatment in adults (Beyond the Basics)" and "Patient education: High blood pressure, diet, and weight (Beyond the Basics)") <span>SUMMARY AND RECOMMENDATIONS ●Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above): •In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]). •Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM. ●In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above): •In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.) However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.) •In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.) •In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.) •In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Patients with chronic kidney disease' above.) •In most older adults (defined as age 65 years or older), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Older adults' above.) However, we suggest a less aggressive systolic goal blood pressure of 135 to 140 mmHg (routine measurements) or 130 to 135 mmHg (non-routine measurements) in patients 75 years or older with a high burden of comorbidity or a diastolic blood pressure <55 to 60 mmHg and also in older adults with postural hypotension. In older adults with severe frailty, dementia, and/or a limited life expectancy or in patients who are nonambulatory or institutionalized (eg, reside in a skilled nursing facility), we individualize goals and share decision making with the patient, relatives, and caretakers, rather than targeting one of the blood pressure goals mentioned above. •In patients with multiple cardiovascular risk factors (but without established cardiovascular disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (standard, routine measurements) or 120 to 125/<80 mmHg (non-routine measurements) if the estimated 10-year risk of a future cardiovascular event is 15 percent or greater (calculator 1) (Grade 1A); we suggest (a weaker recommendation) these lower goals in patients whose estimated 10-year risk is 10 to 14 percent (Grade 2B). (See 'Patients with multiple cardiovascular risk factors' above.) •In lower-risk patients (ie, those without any of the higher-risk characteristics mentioned above), we recommend a goal blood pressure of 130 to 139/<90 mmHg (using standard, routine clinician office measurements) or 125 to 135/<90 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Goal blood pressure in lower-risk patients' above.) Use of UpToDate is subject to the Subscription and License Agreement. REFERENCES Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline







Flashcard 3144071122188

Tags
#blood #goal #pressure
Question

SUMMARY AND RECOMMENDATIONS

● Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above):

• In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour [...]).

• Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM.

● In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above):

• In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.)

However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.)

• In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.)

• In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.)

• In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (

...
Answer
ambulatory blood pressure monitoring [ABPM]


statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
ethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour <span>ambulatory blood pressure monitoring [ABPM]). • Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM. ● In addition, blood press

Original toplevel document

UpToDate
lts (Beyond the Basics)" and "Patient education: High blood pressure treatment in adults (Beyond the Basics)" and "Patient education: High blood pressure, diet, and weight (Beyond the Basics)") <span>SUMMARY AND RECOMMENDATIONS ●Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above): •In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]). •Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM. ●In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above): •In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.) However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.) •In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.) •In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.) •In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Patients with chronic kidney disease' above.) •In most older adults (defined as age 65 years or older), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Older adults' above.) However, we suggest a less aggressive systolic goal blood pressure of 135 to 140 mmHg (routine measurements) or 130 to 135 mmHg (non-routine measurements) in patients 75 years or older with a high burden of comorbidity or a diastolic blood pressure <55 to 60 mmHg and also in older adults with postural hypotension. In older adults with severe frailty, dementia, and/or a limited life expectancy or in patients who are nonambulatory or institutionalized (eg, reside in a skilled nursing facility), we individualize goals and share decision making with the patient, relatives, and caretakers, rather than targeting one of the blood pressure goals mentioned above. •In patients with multiple cardiovascular risk factors (but without established cardiovascular disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (standard, routine measurements) or 120 to 125/<80 mmHg (non-routine measurements) if the estimated 10-year risk of a future cardiovascular event is 15 percent or greater (calculator 1) (Grade 1A); we suggest (a weaker recommendation) these lower goals in patients whose estimated 10-year risk is 10 to 14 percent (Grade 2B). (See 'Patients with multiple cardiovascular risk factors' above.) •In lower-risk patients (ie, those without any of the higher-risk characteristics mentioned above), we recommend a goal blood pressure of 130 to 139/<90 mmHg (using standard, routine clinician office measurements) or 125 to 135/<90 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Goal blood pressure in lower-risk patients' above.) Use of UpToDate is subject to the Subscription and License Agreement. REFERENCES Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline







Flashcard 3144072695052

Tags
#blood #goal #pressure
Question

SUMMARY AND RECOMMENDATIONS

● Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above):

• In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]).

• Overall, routine/conventional measurements provide [...] readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM.

● In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above):

• In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.)

However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.)

• In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.)

• In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.)

• In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (

...
Answer
higher


statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

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ressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]). • Overall, routine/conventional measurements provide <span>higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM. ● In addition, blood pressure targets are based upon the patient's risk for having a fut

Original toplevel document

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lts (Beyond the Basics)" and "Patient education: High blood pressure treatment in adults (Beyond the Basics)" and "Patient education: High blood pressure, diet, and weight (Beyond the Basics)") <span>SUMMARY AND RECOMMENDATIONS ●Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above): •In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]). •Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM. ●In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above): •In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.) However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.) •In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.) •In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.) •In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Patients with chronic kidney disease' above.) •In most older adults (defined as age 65 years or older), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Older adults' above.) However, we suggest a less aggressive systolic goal blood pressure of 135 to 140 mmHg (routine measurements) or 130 to 135 mmHg (non-routine measurements) in patients 75 years or older with a high burden of comorbidity or a diastolic blood pressure <55 to 60 mmHg and also in older adults with postural hypotension. In older adults with severe frailty, dementia, and/or a limited life expectancy or in patients who are nonambulatory or institutionalized (eg, reside in a skilled nursing facility), we individualize goals and share decision making with the patient, relatives, and caretakers, rather than targeting one of the blood pressure goals mentioned above. •In patients with multiple cardiovascular risk factors (but without established cardiovascular disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (standard, routine measurements) or 120 to 125/<80 mmHg (non-routine measurements) if the estimated 10-year risk of a future cardiovascular event is 15 percent or greater (calculator 1) (Grade 1A); we suggest (a weaker recommendation) these lower goals in patients whose estimated 10-year risk is 10 to 14 percent (Grade 2B). (See 'Patients with multiple cardiovascular risk factors' above.) •In lower-risk patients (ie, those without any of the higher-risk characteristics mentioned above), we recommend a goal blood pressure of 130 to 139/<90 mmHg (using standard, routine clinician office measurements) or 125 to 135/<90 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Goal blood pressure in lower-risk patients' above.) Use of UpToDate is subject to the Subscription and License Agreement. REFERENCES Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline







Flashcard 3144074267916

Tags
#blood #goal #pressure
Question

SUMMARY AND RECOMMENDATIONS

● Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above):

• In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]).

• Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM.

● In addition, blood pressure targets are based upon the patient's risk for having a [...] (table 1) (see 'Goal blood pressure in higher-risk patients' above):

• In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.)

However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.)

• In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.)

• In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.)

• In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (

...
Answer
future cardiovascular event


statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

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vide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM. ● In addition, blood pressure targets are based upon the patient's risk for having a <span>future cardiovascular event (table 1 ) (see 'Goal blood pressure in higher-risk patients' above): • In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascu

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UpToDate
lts (Beyond the Basics)" and "Patient education: High blood pressure treatment in adults (Beyond the Basics)" and "Patient education: High blood pressure, diet, and weight (Beyond the Basics)") <span>SUMMARY AND RECOMMENDATIONS ●Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above): •In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]). •Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM. ●In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above): •In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.) However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.) •In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.) •In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.) •In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Patients with chronic kidney disease' above.) •In most older adults (defined as age 65 years or older), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Older adults' above.) However, we suggest a less aggressive systolic goal blood pressure of 135 to 140 mmHg (routine measurements) or 130 to 135 mmHg (non-routine measurements) in patients 75 years or older with a high burden of comorbidity or a diastolic blood pressure <55 to 60 mmHg and also in older adults with postural hypotension. In older adults with severe frailty, dementia, and/or a limited life expectancy or in patients who are nonambulatory or institutionalized (eg, reside in a skilled nursing facility), we individualize goals and share decision making with the patient, relatives, and caretakers, rather than targeting one of the blood pressure goals mentioned above. •In patients with multiple cardiovascular risk factors (but without established cardiovascular disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (standard, routine measurements) or 120 to 125/<80 mmHg (non-routine measurements) if the estimated 10-year risk of a future cardiovascular event is 15 percent or greater (calculator 1) (Grade 1A); we suggest (a weaker recommendation) these lower goals in patients whose estimated 10-year risk is 10 to 14 percent (Grade 2B). (See 'Patients with multiple cardiovascular risk factors' above.) •In lower-risk patients (ie, those without any of the higher-risk characteristics mentioned above), we recommend a goal blood pressure of 130 to 139/<90 mmHg (using standard, routine clinician office measurements) or 125 to 135/<90 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Goal blood pressure in lower-risk patients' above.) Use of UpToDate is subject to the Subscription and License Agreement. REFERENCES Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline







Flashcard 3144075840780

Tags
#blood #goal #pressure
Question

SUMMARY AND RECOMMENDATIONS

● Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above):

• In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]).

• Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM.

● In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above):

• In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of [...] (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.)

However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.)

• In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.)

• In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.)

• In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (

...
Answer
125 to 130/<80 mmHg


statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

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): • In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of <span>125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients wit

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UpToDate
lts (Beyond the Basics)" and "Patient education: High blood pressure treatment in adults (Beyond the Basics)" and "Patient education: High blood pressure, diet, and weight (Beyond the Basics)") <span>SUMMARY AND RECOMMENDATIONS ●Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above): •In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]). •Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM. ●In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above): •In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.) However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.) •In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.) •In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.) •In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Patients with chronic kidney disease' above.) •In most older adults (defined as age 65 years or older), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Older adults' above.) However, we suggest a less aggressive systolic goal blood pressure of 135 to 140 mmHg (routine measurements) or 130 to 135 mmHg (non-routine measurements) in patients 75 years or older with a high burden of comorbidity or a diastolic blood pressure <55 to 60 mmHg and also in older adults with postural hypotension. In older adults with severe frailty, dementia, and/or a limited life expectancy or in patients who are nonambulatory or institutionalized (eg, reside in a skilled nursing facility), we individualize goals and share decision making with the patient, relatives, and caretakers, rather than targeting one of the blood pressure goals mentioned above. •In patients with multiple cardiovascular risk factors (but without established cardiovascular disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (standard, routine measurements) or 120 to 125/<80 mmHg (non-routine measurements) if the estimated 10-year risk of a future cardiovascular event is 15 percent or greater (calculator 1) (Grade 1A); we suggest (a weaker recommendation) these lower goals in patients whose estimated 10-year risk is 10 to 14 percent (Grade 2B). (See 'Patients with multiple cardiovascular risk factors' above.) •In lower-risk patients (ie, those without any of the higher-risk characteristics mentioned above), we recommend a goal blood pressure of 130 to 139/<90 mmHg (using standard, routine clinician office measurements) or 125 to 135/<90 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Goal blood pressure in lower-risk patients' above.) Use of UpToDate is subject to the Subscription and License Agreement. REFERENCES Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline







Flashcard 3144077413644

Tags
#blood #goal #pressure
Question

SUMMARY AND RECOMMENDATIONS

● Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above):

• In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]).

• Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM.

● In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above):

• In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or [...] (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.)

However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.)

• In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.)

• In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.)

• In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (

...
Answer
120 to 125/<80 mmHg


statusnot learnedmeasured difficulty37% [default]last interval [days]               
repetition number in this series0memorised on               scheduled repetition               
scheduled repetition interval               last repetition or drill

Parent (intermediate) annotation

Open it
or history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or <span>120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.) However, in hyperten

Original toplevel document

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lts (Beyond the Basics)" and "Patient education: High blood pressure treatment in adults (Beyond the Basics)" and "Patient education: High blood pressure, diet, and weight (Beyond the Basics)") <span>SUMMARY AND RECOMMENDATIONS ●Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above): •In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]). •Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM. ●In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above): •In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.) However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.) •In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.) •In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.) •In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Patients with chronic kidney disease' above.) •In most older adults (defined as age 65 years or older), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Older adults' above.) However, we suggest a less aggressive systolic goal blood pressure of 135 to 140 mmHg (routine measurements) or 130 to 135 mmHg (non-routine measurements) in patients 75 years or older with a high burden of comorbidity or a diastolic blood pressure <55 to 60 mmHg and also in older adults with postural hypotension. In older adults with severe frailty, dementia, and/or a limited life expectancy or in patients who are nonambulatory or institutionalized (eg, reside in a skilled nursing facility), we individualize goals and share decision making with the patient, relatives, and caretakers, rather than targeting one of the blood pressure goals mentioned above. •In patients with multiple cardiovascular risk factors (but without established cardiovascular disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (standard, routine measurements) or 120 to 125/<80 mmHg (non-routine measurements) if the estimated 10-year risk of a future cardiovascular event is 15 percent or greater (calculator 1) (Grade 1A); we suggest (a weaker recommendation) these lower goals in patients whose estimated 10-year risk is 10 to 14 percent (Grade 2B). (See 'Patients with multiple cardiovascular risk factors' above.) •In lower-risk patients (ie, those without any of the higher-risk characteristics mentioned above), we recommend a goal blood pressure of 130 to 139/<90 mmHg (using standard, routine clinician office measurements) or 125 to 135/<90 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Goal blood pressure in lower-risk patients' above.) Use of UpToDate is subject to the Subscription and License Agreement. REFERENCES Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline







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SUMMARY AND RECOMMENDATIONS

● Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above):

• In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]).

• Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM.

● In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above):

• In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.)

However, in hypertensive patients who have had a recent (two weeks to six months) [...] (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.)

• In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.)

• In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.)

• In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (Se

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stroke associated with uncorrected hemodynamically significant large artery disease


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pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.) However, in hypertensive patients who have had a recent (two weeks to six months) <span>stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other t

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lts (Beyond the Basics)" and "Patient education: High blood pressure treatment in adults (Beyond the Basics)" and "Patient education: High blood pressure, diet, and weight (Beyond the Basics)") <span>SUMMARY AND RECOMMENDATIONS ●Our proposed blood pressure targets depend in part upon the method by which the blood pressure is measured (see 'Importance of how blood pressure is measured' above): •In particular, blood pressure may be measured in a standard, routine fashion (usually a single, manual measurement in the office with a stethoscope or oscillometric device) or measured using other methods (automatic oscillometric blood pressure monitoring [AOBPM] performed in the office, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring [ABPM]). •Overall, routine/conventional measurements provide higher readings than non-routine measurements including AOBPM, home blood pressure monitoring, or ABPM. ●In addition, blood pressure targets are based upon the patient's risk for having a future cardiovascular event (table 1) (see 'Goal blood pressure in higher-risk patients' above): •In most patients with established atherosclerotic cardiovascular disease (prior history of coronary, cerebrovascular, or peripheral arterial disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1A). (See 'Patients with established atherosclerotic cardiovascular disease' above.) However, in hypertensive patients who have had a recent (two weeks to six months) stroke associated with uncorrected hemodynamically significant large artery disease (ie, of the internal carotid, middle cerebral, vertebral, or basilar artery), we suggest cautious blood pressure lowering as tolerated but without a specific blood pressure goal other than a minimum reduction of 10/5 mmHg (Grade 2C). (See 'Prior history of ischemic stroke or transient ischemic attack' above.) •In patients with heart failure and reduced ejection fraction (HFrEF), we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2C). (See 'Patients with heart failure' above.) •In most patients with diabetes, we suggest a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 2B). (See 'Patients with diabetes mellitus' above.) •In patients with chronic kidney disease (CKD), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Patients with chronic kidney disease' above.) •In most older adults (defined as age 65 years or older), we recommend a goal blood pressure of 125 to 130/<80 mmHg (using standard, routine clinician office measurements) or 120 to 125/<80 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Older adults' above.) However, we suggest a less aggressive systolic goal blood pressure of 135 to 140 mmHg (routine measurements) or 130 to 135 mmHg (non-routine measurements) in patients 75 years or older with a high burden of comorbidity or a diastolic blood pressure <55 to 60 mmHg and also in older adults with postural hypotension. In older adults with severe frailty, dementia, and/or a limited life expectancy or in patients who are nonambulatory or institutionalized (eg, reside in a skilled nursing facility), we individualize goals and share decision making with the patient, relatives, and caretakers, rather than targeting one of the blood pressure goals mentioned above. •In patients with multiple cardiovascular risk factors (but without established cardiovascular disease), we recommend a goal blood pressure of 125 to 130/<80 mmHg (standard, routine measurements) or 120 to 125/<80 mmHg (non-routine measurements) if the estimated 10-year risk of a future cardiovascular event is 15 percent or greater (calculator 1) (Grade 1A); we suggest (a weaker recommendation) these lower goals in patients whose estimated 10-year risk is 10 to 14 percent (Grade 2B). (See 'Patients with multiple cardiovascular risk factors' above.) •In lower-risk patients (ie, those without any of the higher-risk characteristics mentioned above), we recommend a goal blood pressure of 130 to 139/<90 mmHg (using standard, routine clinician office measurements) or 125 to 135/<90 mmHg (using other methodology including AOBPM, home blood pressure, and ABPM) (Grade 1B). (See 'Goal blood pressure in lower-risk patients' above.) Use of UpToDate is subject to the Subscription and License Agreement. REFERENCES Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline







#english #game #strauss
You asked how to tell if she's ready. The way to tell is the other three- second rule. It works 100 percent of the time. While sitting close, just let the conversation trail off Look her in the eye while you pause the conversation. If she looks back for a count of three seconds, she wants to kiss. The uncomfort- ableness you may experience is my favorite thing in the whole world—sexual tension.

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#english #game #strauss
1. I have her come over to pick me up and only let her stay a couple minutes.This is because it's a lot easier to get a woman back to your house at the end of the night if you've already had her over and nothing has happened. 2. At the end of the date, I invite her back to my place and pour drinks. 3. If she notices my guitar (it is prominently placed], I pick it up and play her a song. 4. We play with my puppy. 5. I show her the rooftop. 6. I bring her back to the apartment and show her the Winamp music program on my computer while I sit her down on my lap. While she's playing with the visualizations in Winamp, I kiss her on the cheek. 7. She either turns and kisses me on the lips, or she continues playing with Winamp. If she hesitates, I just show her more things on the computer and then kiss her on the cheek again. She wants to be directed and ordered about. That is what almost all women want. 8. You can figure out the rest. —Maddash

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#english #game #strauss
When we're back at my place, I tell her I'm sore from playing basketball and need a back massage. But during the massage, I constantly tell her she's doing it all wrong. Finally, I pretend to be exasperated and insist on showing her how its done. While massaging her back, I tell her she carries a lot of tension in her legs and that I give amazing leg massages to my friends. I start to massage her through her pants, but then tell her to remove them because they're getting in the way. If you act as if you are the authority, she will not question you. At first, I stick to the legs. But, slowly, I work my way up to her buttocks. When she begins to get turned on, I begin rubbing her through her panties until she's dripping wet. At this point, I usually just unbutton my pants, put on a con- dom, and start fucking her without kissing or actual foreplay.

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It helps to just think of the girl as practice. If the fear is still there inside, just say, "Phase-shift! I'm now a caveman! I'm no longer Style. Lets see if she hates me. If so, fuck it. I don't give a shit." Look back to girls you didn't caveman, and they aren't in your life. So fuck- ing what? Do you care that she has a fond memory of some guy she met six months ago while a caveman is now fucking her? You gotta actually hit on her sometime. Say, "Stick your tongue out." Then suck on it. If she slaps you, good! That story would rock.

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