Cardiology Series: Case 7

A 62-year old patient comes to your clinic complaining of frequent headaches at the back of the head, particularly in the morning. She describes lightheadedness and occasional buzzing at the ears. These symptoms had started over the last month.
When measuring the blood pressure, you get a reading of 170/110 mmHg.
You decide to set up a 24-hour blood pressure monitor. You find that she had a constant systolic of 165 mmHg and a diastolic of 105 mmHg. She was diagnosed with hypertension.

1. What stage of hypertension is this lady in ?

2. What are the causes of hypertension ? 

3. How would you investigate this patient ? (keeping in mind the causes above).

4. Describe the standard treatment of hypertension.

5. What are the major complications of uncontrolled hypertension ?

Source: https://www.ncbi.nlm.nih.gov/pubmed/15561162

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ANSWERS

1. Stage 2 hypertension

Source: https://heartengine.org/2016/05/05/making-heads-or-tails-of-blood-pressure-readings/

2. Causes of Hypertension

Source: https://skinrenew.blogspot.com.mt/2015/02/homeopathy-for-hypertension-hypotension.html

3. Investigations 

To help quantify overall risk: Fasting Blood Glucose and Lipid Profile for Cholesterol
To look for end-organ damage: ECG (for LV hypertrophy or Past MI) and Urinalysis to check for protein and blood.
To exclude secondary causes: U&E (hypokalaemia in Conn’s syndrome), Ca2+ for Hyperparathyroidism

Specific Tests: Renal US/arteriography for reanl artery stenosis, 24H urine metanephrines, Urinary free cortisol, Renin in serum, Aldosterone, MR aorta (aortic coarctation).

Additional Test: Echocardiography to look for Left Ventricular Hypertrophy

4. Standard Treatment of Hypertension

Lifestyle Changes: Dietary changes with low sodium, Physical Exercise

First Line Antihypertensives include:

• Thiazide Diuretics e.g. Bendroflumethiazide
• Calcium Channel Blockers e.g. Verapamil
• ACE-inhibitors e.g. perindopril
• Angiotensin Receptor Blocekrs e.g. valsartan

5. Complications of uncontrolled hypertension

Source: https://auroraforeveryone.wordpress.com/2015/07/07/hypertension-high-blood-pressure/