6637 Week 1: Medical Billing and Chronic Disease
Guidelines|Blood Pressure Measurement, Hypertension, Masked
& White Coat HTN, Secondary & Uncommon Causes, Thiazide,
ACE-I, ARB, CCB, Lifestyle Modification, DASH Diet, Sodium &
Potassium, Asthma Stepwise Management, ICS, LABA, SABA,
COPD Classification, Exacerbation Management, Smoking
Cessation, Dyslipidemia Primary & Secondary Prevention, Statins,
Ezetimibe, PCSK9 Inhibitors, Preventive Care, Vaccination,
Documentation, SOAP, E/M, ICD-10, CPT Coding, Patient
Education, Cardiovascular Risk, Nonpharmacologic Therapy,
Pharmacologic Therapy Exam Questions Verified and Provided
with Complete A+ Graded Rationales Latest Updated 2026
Checklist for accurate measurement of BP 1 - properly prepare the patient
1. Have the patient relax, sitting in a chair (feet on floor, back supported) for >5 min.2. The patient
should avoid caffeine, exercise, and smoking for at least 30 min before measurement.3. Ensure patient
has emptied his/her bladder.4. Neither the patient nor the observer should talk during the rest period or
during the measurement.5. Remove all clothing covering the location of cuff placement.6.
Measurements made while the patient is sitting or lying on an examining table do not fulfill these
criteria.
Checklist for accurate measurement of BP 2 use proper technique for BP measurements
1. Use a BP measurement device that has been validated, and ensure that the device is calibrated
periodically.*2. Support the patient's arm (eg, resting on a desk).3. Position the middle of the cuff on the
patient's upper arm at the level of the right atrium (the midpoint of the sternum).4. Use the correct cuff
size, such that the bladder encircles 80% of the arm, and note if a larger- or smaller-than-normal cuff
size is used (Table 9).5. Either the stethoscope diaphragm or bell may be used for auscultatory readings
Checklist for accurate measurement of BP 3 Take the proper measurements needed for diagnosis and
treatment of elevated BP/HTN
,At the first visit, record BP in both arms. Use the arm that gives the higher reading for subsequent
readings.2. Separate repeated measurements by 1-2 min.3. For auscultatory determinations, use a
palpated estimate of radial pulse obliteration pressure to estimate SBP. Inflate the cuff 20-30 mm Hg
above this level for an auscultatory determination of the BP level.4. For auscultatory readings, deflate
the cuff pressure 2 mm Hg per second, and listen for Korotkoff sounds.
Checklist for accurate measurement of BP 4 properly document accurate BP readings
1. Record SBP and DBP. If using the auscultatory technique, record SBP and DBP as onset of the first
Korotkoff sound and disappearance of all Korotkoff sounds, respectively, using the nearest even
number.2. Note the time of most recent BP medication taken before measurements.
Checklist for accurate measurement of BP 5 Average the readings
Use an average of ≥2 readings obtained on ≥2 occasions to estimate the individual's level of BP.
Checklist for accurate measurement of BP 6 provide BP readings to patient
Provide patients the SBP/DBP readings both verbally and in writing.
Recommendation for out of office and self monitoring BP
Out of office BP measurements are recommended to confirm the diagnosis of htn and for titration of BP-
lowering medication, in conjunction with telehealth counseling or clinical interventions
Masked and White Coat HTN
The availability of noninvasive BP monitoring techniques has resulted in differentiation of hypertension
into several clinically useful categories that are based on the place of BP measurement (Table 12).S4.4-
1,S4.4-13,S4.4-14 These include masked hypertension and white coat hypertension, in addition to
sustained hypertension. White coat hypertension is characterized by elevated office BP but normal
readings when measured outside the office with either ABPM or HBPM. In contrast, masked
hypertension is characterized by office readings suggesting normal BP but out-of-office (ABPM/HBPM)
, readings that are consistently above normal.S4.4-15 In sustained hypertension, BP readings are elevated
in both office and out-of-office settings.
Causes of HTN
Genetic predisposition
Environmental risk factors
Overweight and obesity
Sodium intake
Potassium - a higher level of potassium seems to blunt the effect of sodium on BP, lower sodium-
potassium associated with lower BP
Physical fitness
Alcohol
General principles of documentation
Medical record should be complete and legible
Documentation (SOAP) should include:
Subjective
Objective
Assessment (diagnosis)
Plan
Subjective
Chief complaint (HPI)
History (medical, surgical, social)
Review of systems
Guidelines|Blood Pressure Measurement, Hypertension, Masked
& White Coat HTN, Secondary & Uncommon Causes, Thiazide,
ACE-I, ARB, CCB, Lifestyle Modification, DASH Diet, Sodium &
Potassium, Asthma Stepwise Management, ICS, LABA, SABA,
COPD Classification, Exacerbation Management, Smoking
Cessation, Dyslipidemia Primary & Secondary Prevention, Statins,
Ezetimibe, PCSK9 Inhibitors, Preventive Care, Vaccination,
Documentation, SOAP, E/M, ICD-10, CPT Coding, Patient
Education, Cardiovascular Risk, Nonpharmacologic Therapy,
Pharmacologic Therapy Exam Questions Verified and Provided
with Complete A+ Graded Rationales Latest Updated 2026
Checklist for accurate measurement of BP 1 - properly prepare the patient
1. Have the patient relax, sitting in a chair (feet on floor, back supported) for >5 min.2. The patient
should avoid caffeine, exercise, and smoking for at least 30 min before measurement.3. Ensure patient
has emptied his/her bladder.4. Neither the patient nor the observer should talk during the rest period or
during the measurement.5. Remove all clothing covering the location of cuff placement.6.
Measurements made while the patient is sitting or lying on an examining table do not fulfill these
criteria.
Checklist for accurate measurement of BP 2 use proper technique for BP measurements
1. Use a BP measurement device that has been validated, and ensure that the device is calibrated
periodically.*2. Support the patient's arm (eg, resting on a desk).3. Position the middle of the cuff on the
patient's upper arm at the level of the right atrium (the midpoint of the sternum).4. Use the correct cuff
size, such that the bladder encircles 80% of the arm, and note if a larger- or smaller-than-normal cuff
size is used (Table 9).5. Either the stethoscope diaphragm or bell may be used for auscultatory readings
Checklist for accurate measurement of BP 3 Take the proper measurements needed for diagnosis and
treatment of elevated BP/HTN
,At the first visit, record BP in both arms. Use the arm that gives the higher reading for subsequent
readings.2. Separate repeated measurements by 1-2 min.3. For auscultatory determinations, use a
palpated estimate of radial pulse obliteration pressure to estimate SBP. Inflate the cuff 20-30 mm Hg
above this level for an auscultatory determination of the BP level.4. For auscultatory readings, deflate
the cuff pressure 2 mm Hg per second, and listen for Korotkoff sounds.
Checklist for accurate measurement of BP 4 properly document accurate BP readings
1. Record SBP and DBP. If using the auscultatory technique, record SBP and DBP as onset of the first
Korotkoff sound and disappearance of all Korotkoff sounds, respectively, using the nearest even
number.2. Note the time of most recent BP medication taken before measurements.
Checklist for accurate measurement of BP 5 Average the readings
Use an average of ≥2 readings obtained on ≥2 occasions to estimate the individual's level of BP.
Checklist for accurate measurement of BP 6 provide BP readings to patient
Provide patients the SBP/DBP readings both verbally and in writing.
Recommendation for out of office and self monitoring BP
Out of office BP measurements are recommended to confirm the diagnosis of htn and for titration of BP-
lowering medication, in conjunction with telehealth counseling or clinical interventions
Masked and White Coat HTN
The availability of noninvasive BP monitoring techniques has resulted in differentiation of hypertension
into several clinically useful categories that are based on the place of BP measurement (Table 12).S4.4-
1,S4.4-13,S4.4-14 These include masked hypertension and white coat hypertension, in addition to
sustained hypertension. White coat hypertension is characterized by elevated office BP but normal
readings when measured outside the office with either ABPM or HBPM. In contrast, masked
hypertension is characterized by office readings suggesting normal BP but out-of-office (ABPM/HBPM)
, readings that are consistently above normal.S4.4-15 In sustained hypertension, BP readings are elevated
in both office and out-of-office settings.
Causes of HTN
Genetic predisposition
Environmental risk factors
Overweight and obesity
Sodium intake
Potassium - a higher level of potassium seems to blunt the effect of sodium on BP, lower sodium-
potassium associated with lower BP
Physical fitness
Alcohol
General principles of documentation
Medical record should be complete and legible
Documentation (SOAP) should include:
Subjective
Objective
Assessment (diagnosis)
Plan
Subjective
Chief complaint (HPI)
History (medical, surgical, social)
Review of systems
