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Operations Directorate, Health Branch

Immigration Medical Examination Instructions

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Subject

Instructions or the screening o clients with high blood pressure in the context othe Canadian immigration medical examination (IME).

Goal/Objective

Tese instructions are provided to ensure that Panel Physicians (PPs) ollow aconsistent and appropriate process in their:

Identication o clients with hypertension;

Further investigation o clients with hypertension in order to provide allthe inormation that will allow the medical ofcer to assess the potentialmedical service requirements needed or the client; and

Completion and grading o an IME with hypertension.

InstructionsScreening and testing

Measure o the blood pressure is a mandatory and essential part o any medicalexamination. High blood pressure is a serious cardiovascular condition withrepercussions o several vital organs.

During medical questionnaire, PPs will emphasize on detection o cardiovascularrisk actors such as: smoking, excess body weight, low levels o physical activity andpoor eating habits which are o utmost importance. It is also important to question

on possible symptoms o hypertension such as headache, dizziness, blurred vision,nausea and vomiting, and chest pain and shortness o breath. I an interpreteris used, PPs must select and ensure that the interpreter is unbiased and has noconnection to the client. Family members or riends cannot act as an interpreter ora client. Te use o a proessional interpreter is at the clients expense.

During the physical examination, PPs will pay special attention when taking theblood pressure and identiy signs associated with end-organ damage:

Fundoscopy is necessary to assess retinopathy;

Check or symptoms or ndings such as peripheral anaesthetic neuropathy

or pain, autonomic neuropathy e.g. erectile dysunction, gastrointestinaldisturbance, orthostatic hypotension. Include screening via monolamentduring oot exam;

Chest auscultation/radiography is necessary to assess cardiomegaly andcardiopathy; and

o assess nephropathy, special attention should be brought during the IMEto blood pressure measure as well as to urinalysis result.

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Blood Pressure screening:

Blood pressure measurement is required or all clients 15 years.

Blood pressure measurement is required or all clients < 15 years i theypresent with abnormal medical history or clinical ndings such as:

- Are seriously overweight/underweight or known diabetic;

- Stayed in the ICU (intensive care unit) or any amount o time aterbirth;

- Have/had any known heart, lung or circulatory problems; or

- Experienced any complications or difculty beore, during, orshortly ater birth.

High blood pressure is dened as a repeated blood pressure (repeated 3times) measured in the doctors ofce, o:

- 140mmHg systolic pressure; or

- 90 mm Hg diastolic pressure.

Note: Interpretation o blood pressure readings in the pediatric population requiresadapted equipment and can be complicated; please reer to Blood Pressure ables

or Children and Adolescents (see link below in reerences).

Once hypertension/cardiac disease is identied during the IME, questions that willassist the Regional Medical Ofce in their assessment o the IME are:

Diagnosis and prognosis;

Duration and progression o symptoms;

Level o unctioning (e.g. provide the internationally accepted New YorkHeart Association unctional Classication);

Details o past investigations and treatments (medications, reerrals,hospitalizations, surgery, etc);

Any specialist reports available rom previous consultations;

Current medications used to treat the disease; and

Anticipated treatment needed (surgery, etc).

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HypertensionAdditional investigation required

Additional testing is required or clients identied with hypertension in order torule out cardiac disease.

Serum creatinine testing (reer to IMEI Serum Creatinine).

Reerral to a cardiologistor assessment, investigation and determination othe prognosis and the need or treatment must also be done when there is ahistory or clinical evidence o:

- Coronary artery disease;

- Valvular heart disease;

- Cardiomyopathy;

- Congenital heart disease; and/or

- Peripheral (including cerebral) vascular disease.

Reporting

Any available additional testing must be attached to the IME report.

Any specialist report that may be available rom previous consultations

should also be attached.

Grading

All IMEs with hypertension must be graded B.


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HypertensionAlgorithm


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HypertensionReferences

Cardiovascular disease guidelines, BChttp://www.bcguidelines.ca/guideline_cvd.html#gure_1

New York Heart Association Functional Classication:http://www.cebp.nl/media/m149.pd

Blood Pressure ables or Children and Adolescentshttp://highbloodpressure.about.com/od/newlydiagnosed/a/kids_bp_charts.html

http://www.nhlbi.nih.gov/guidelines/hypertension/child_tbl.pd

HB Approval and Authority

Director General, NHQ, Health Branch, CIC

Implementation Date

2012/11/01

Revision Date(s)

2013/11/01

imei hypertension

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