# Situation: A 62-year-old man is brought to the emergency room (ER) because of a severe headache, blurred vision, and new confusion since this morning. He stopped taking his amlodipine and losartan 2 weeks ago. His blood pressure is 220/130 mmHg on repeated readings, and a head computed tomography (CT) scan shows no bleeding. Before discharge, the nurse teaches him home blood pressure monitoring. Under the Philippine clinical practice guidelines for hypertension, hypertension is diagnosed at a clinic blood pressure at or above which value, confirmed on repeated readings?

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## 문제

Situation: A 62-year-old man is brought to the emergency room (ER) because of a severe headache, blurred vision, and new confusion since this morning. He stopped taking his amlodipine and losartan 2 weeks ago. His blood pressure is 220/130 mmHg on repeated readings, and a head computed tomography (CT) scan shows no bleeding.

Before discharge, the nurse teaches him home blood pressure monitoring. Under the Philippine clinical practice guidelines for hypertension, hypertension is diagnosed at a clinic blood pressure at or above which value, confirmed on repeated readings?

## 보기

1. 140/90 mmHg **✔ 정답**
2. 160/100 mmHg
3. 130/80 mmHg
4. 120/80 mmHg

**정답: 1**

## 해설

The Philippine clinical practice guidelines for hypertension, issued by the Philippine Heart Association and the Philippine Society of Hypertension, define hypertension as a clinic blood pressure of 140/90 mmHg or higher, confirmed on repeated readings. The current U.S. guideline uses 130/80 mmHg, which is why the stem names the Philippine guideline.

## 심화 해설

Clinical context

This patient presents with a hypertensive emergency profile: severe headache, blurred vision, new confusion, and a blood pressure of 220/130 mmHg after stopping amlodipine and losartan. The head CT shows no intracranial bleeding, which helps rule out hemorrhagic stroke, but the clinical picture still reflects acute hypertension-mediated organ dysfunction. The question, however, shifts to a preventive teaching point: what clinic blood pressure threshold defines hypertension under the Philippine clinical practice guidelines.

Diagnostic threshold in the Philippine guideline

The 2020 Philippine Clinical Practice Guidelines for the management of hypertension define hypertension as a clinic blood pressure of 140/90 mmHg or higher, confirmed on repeated readings. This threshold is the same as that used by many international societies outside the United States and reflects a practical balance between identifying true cardiovascular risk and avoiding overdiagnosis in a setting where hypertension control remains poor.

The guideline was developed because hypertension is the most common cause of death and disability worldwide, with prevalence rising in low- and middle-income countries such as the Philippines. Poor blood pressure control is identified as one of the main causes of hypertension-related morbidity and mortality in the country [1]. A unified local threshold supports consistent screening, diagnosis, and follow-up across primary care and hospital settings.

Why the stem names the Philippine guideline

The United States guideline, from the American College of Cardiology and American Heart Association, uses a lower threshold of 130/80 mmHg. That is why option 3 is incorrect in this question. The Philippine guideline intentionally retains the 140/90 mmHg cutoff. This distinction is a common licensure examination point because examinees may be more familiar with the U.S. classification.

The key principle is that the diagnostic cutoff depends on which guideline is being applied, and the stem explicitly directs attention to the Philippine clinical practice guidelines.

Why repeated readings matter

A single elevated reading is not enough to diagnose chronic hypertension. Stress, pain, caffeine, or the emergency room environment itself can transiently raise blood pressure. The guideline requires confirmation on repeated readings, typically on separate visits, before labeling a person as hypertensive. In this patient, the repeated readings of 220/130 mmHg confirm severe hypertension, but the diagnostic threshold for the general population remains 140/90 mmHg.

Key point! The Philippine threshold for hypertension is 140/90 mmHg, not 130/80 mmHg. The lower value belongs to the U.S. guideline.

Watch out! 120/80 mmHg is considered normal or optimal blood pressure, not the diagnostic cutoff for hypertension in either guideline.

Clinical application to this patient

The patient stopped amlodipine, a dihydropyridine calcium channel blocker, and losartan, an angiotensin II receptor blocker, two weeks before presentation. Abrupt discontinuation of antihypertensive therapy can lead to rebound hypertension, especially with agents that suppress the renin-angiotensin system. His current blood pressure far exceeds the diagnostic threshold, but the diagnosis of hypertension was already established before this visit. The teaching point about home blood pressure monitoring is therefore aimed at preventing recurrence of uncontrolled hypertension and recognizing when to seek care.

Home blood pressure monitoring supports the guideline’s emphasis on repeated readings outside the clinic. It helps distinguish sustained hypertension from white-coat elevation and guides medication adherence. For this patient, the nurse should teach that a home reading at or above 135/85 mmHg is generally considered elevated, although the formal clinic diagnostic threshold remains 140/90 mmHg. The question asks specifically about the clinic threshold, so the correct answer is 140/90 mmHg.

| Guideline | Clinic diagnostic threshold | Clinical implication |
| --- | --- | --- |
| 2020 Philippine CPG | 140/90 mmHg or higher | Standard for diagnosis and follow-up in the Philippines |
| 2017 ACC/AHA (U.S.) | 130/80 mmHg or higher | Lower threshold; more people classified as hypertensive |
| Normal or optimal | Below 120/80 mmHg | Not diagnostic of hypertension |

The Philippine guideline defines hypertension at a clinic blood pressure of 140/90 mmHg or higher, confirmed on repeated readings, because this threshold balances diagnostic accuracy with the practical realities of hypertension control in the Philippine population [1].References (research sources)

- [1]Executive summary of the 2020 clinical practice guidelines for the management of hypertension in the Philippines.GuidelineOna DID, Jimeno CA, Jasul GV, Bunyi MLE, Oliva R, Gonzalez-Santos LE (2021) · DOI: 10.1111/jch.14335

## 임상 시나리오

Philippine CPG Hypertension DiagnosisClinic BP threshold for diagnosis
Under the 2020 Philippine Clinical Practice Guidelines, hypertension is diagnosed at a clinic blood pressure of 140/90 mmHg or higher, confirmed on repeated readings. This threshold aligns with many international societies outside the U.S. and supports consistent screening in primary care.

The U.S. ACC/AHA guideline uses a lower cutoff of 130/80 mmHg, which is why the question specifies the Philippine guideline. Do not confuse the two thresholds.

CautionA single elevated reading does not confirm hypertension. Diagnosis requires confirmation on repeated clinic visits unless the patient presents with hypertensive emergency or severe elevation.

## 핵심 개념

- **Hypertension** — Persistently elevated blood pressure; diagnosed at clinic BP 140/90 mmHg or higher per Philippine CPG.
- **Clinic blood pressure** — BP measured in a clinical setting, used for diagnosis when elevated on repeated readings.
- **Philippine CPG** — 2020 Philippine Clinical Practice Guidelines by PHA and PSH, defining hypertension threshold.
- **Hypertensive emergency** — Severe BP elevation with acute target-organ damage, as suggested by headache, confusion, and visual changes.
- **Amlodipine** — Calcium channel blocker antihypertensive; abrupt cessation can cause rebound severe hypertension.

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