Medical Emergencies · patient case question
Under the 2017 ACC/AHA guideline, how is a blood pressure of 145/92 mmHg classified?
Patient case: Elevated blood pressure and swollen gums
Patient: Male, 62 years old
Chief Complaint: “My gums have grown over my teeth.”
Background: Hypertension for eight years and angina. Current medications: nifedipine, atorvastatin, low-dose aspirin. Non-smoker. He reports brushing twice daily.
Vital Signs: BP 145/92 mmHg (repeated, seated, correct cuff) · HR 76 bpm · RR 16
Findings: Firm, fibrotic, nodular enlargement of the interdental papillae, most pronounced anteriorly and facially. Moderate plaque. No spontaneous bleeding.
Show answer and explanation
Correct answer: B. Stage 2 hypertension
- A. The elevated category has a diastolic under 80 by definition; 92 excludes it.
- B. CORRECT. The 2017 ACC/AHA thresholds are: normal below 120/80; ELEVATED 120–129 systolic with diastolic under 80; STAGE 1 at 130–139 or 80–89; STAGE 2 at 140 or above, or 90 or above. When systolic and diastolic fall in different categories, the HIGHER one governs. At 145/92 both values sit in stage 2.
- C. Stage 1 tops out at 139/89. Both of this patient's numbers exceed that.
- D. Hypertensive crisis begins at 180/120, at which point elective dental care is deferred and the patient needs urgent medical evaluation.
Note: Under the older JNC 7 framework 145/92 was Stage 1, and some recall documents in this series still use that scale. INBDE follows the 2017 ACC/AHA guideline, so 140/90 and above is Stage 2.
Practice Medical Emergencies questions Medical Emergencies study notes