Clinical Reference Values

Why Exact Cut-Points Matter

Task B, Knowledge g-i requires memorizing the current, numeric clinical reference values for plasma cholesterol, blood pressure, and blood glucose. These values are tested directly, such as "classify this blood pressure reading," and indirectly, since they define terms like hypertension and impaired fasting glucose from Section 4.3 and determine whether a finding belongs in the cardiovascular or metabolic risk-factor categories that trigger physician consultation. Get the exact numbers wrong and both direct-recall items and downstream risk-classification items will be wrong.

Plasma Cholesterol (Lipid Panel)

The classification below follows the National Cholesterol Education Program Adult Treatment Panel (NCEP/ATP) guidelines referenced directly in the outline (Task B, Knowledge g). All values are mg/dL, fasting.

Two counterintuitive points are frequently tested. First, HDL-C runs opposite to the other lipids: a low HDL-C is the risk factor, while a high HDL-C of 60 mg/dL or above is protective enough to count as a negative risk factor in traditional risk counting. Second, LDL-C, not TC, is the primary classification and treatment target in current lipid management, even though total cholesterol is what many worksite screenings report to clients first.

Blood Pressure (Current ACC/AHA Classification)

The current ACC/AHA classification, introduced in the 2017 guideline and reaffirmed with unchanged category boundaries by the 2025 update, replaced the older "prehypertension" terminology. A reading is classified by whichever value -- systolic or diastolic -- triggers the higher-severity category.

A reading of 128/82 mmHg is Stage 1, not "Elevated," because the diastolic value of 82 already exceeds the Elevated category's diastolic ceiling of <80 -- classification always takes the higher-severity category triggered by either number, not just the systolic value. A hypertensive-crisis reading requires immediate medical attention and is an absolute stop-exercise finding regardless of the client's activity/disease-status branch in the Section 4.1 algorithm.

Blood Glucose (Current ADA Criteria)

Blood glucose status is most often assessed by fasting plasma glucose (FPG); the outline also expects familiarity with the related oral glucose tolerance test (OGTT) and A1C criteria, since impaired fasting glucose and impaired glucose tolerance (Section 4.3) are technically distinct diagnoses.

Impaired fasting glucose and impaired glucose tolerance are related but not identical -- a client can have one without the other, and either one independently satisfies the metabolic risk-factor trigger for physician consultation from Section 4.3. A single diabetes-range result is typically confirmed with a repeat test on a separate day; the EP-C does not diagnose diabetes but must recognize a diabetes-range reading as a mandatory referral trigger.

Where These Values Converge: Metabolic Syndrome

The cholesterol, blood pressure, and glucose values in this section are not just independent facts -- three of them are also diagnostic criteria for metabolic syndrome, the metabolic risk factor introduced in Section 4.3. A client meets the metabolic syndrome cluster with any three of five findings: elevated waist circumference, triglycerides at or above 150 mg/dL, HDL-C below 40 mg/dL in men or below 50 mg/dL in women, blood pressure at or above 130/85 mmHg, and fasting glucose at or above 100 mg/dL. Notice that the blood pressure and glucose thresholds used inside the metabolic syndrome definition are not identical to the ACC/AHA Stage 1 (130/80 mmHg) or ADA prediabetes (100 mg/dL) cut-points used elsewhere in this chapter -- read exam items carefully to see which definition is being invoked. All values in this section should be obtained under standardized conditions: a fasting lipid panel is drawn after a 9-12 hour fast, and blood pressure should be measured after 5 minutes of quiet seated rest using a properly sized cuff, since a rushed or non-fasting measurement can shift a client into the wrong category entirely.

Using These Values Correctly on the Exam

Expect items that hand you a single number, such as "a client's fasting glucose is 118 mg/dL," and ask you to classify it, and items that combine a value with the Section 4.1 algorithm, such as a client with a 142/88 mmHg reading -- Stage 2 -- requesting to begin a vigorous program. Memorize the boundary numbers precisely: 100 and 126 for glucose, 200 and 240 for cholesterol, and 120, 130, and 140 for blood pressure systolic breakpoints, since exam items are frequently written right at a category boundary to test exact recall, not general familiarity.