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    Hypertension CASE REPORT

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    Julienne Sanchez-Salazar
    This case presents a 54-year-old Filipino woman who presented with dizziness and nausea. Her blood pressure was elevated at 200/120. She has a history of hypertension for 15 years but is non-compliant with her Losartan medication. Differential diagnoses considered include benign paroxysmal positional vertigo and hypertensive urgency. She was admitted for management of her hypertensive urgency, including restarting her antihypertensive medication under medical supervision. Diagnostics showed elevated blood pressure but no other abnormalities. Her admitting diagnosis was hypertensive urgency.

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    Hypertension CASE REPORT

    Uploaded by

    Julienne Sanchez-Salazar
    56 views57 pages
    This case presents a 54-year-old Filipino woman who presented with dizziness and nausea. Her blood pressure was elevated at 200/120. She has a history of hypertension for 15 years but is non-compliant with her Losartan medication. Differential diagnoses considered include benign paroxysmal positional vertigo and hypertensive urgency. She was admitted for management of her hypertensive urgency, including restarting her antihypertensive medication under medical supervision. Diagnostics showed elevated blood pressure but no other abnormalities. Her admitting diagnosis was hypertensive urgency.

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    This case presents a 54-year-old Filipino woman who presented with dizziness and nausea. Her blood pressure was elevated at 200/120. She has a history of hypertension for 15 years but is non-compliant with her Losartan medication. Differential diagnoses considered include benign paroxysmal positional vertigo and hypertensive urgency. She was admitted for management of her hypertensive urgency, including restarting her antihypertensive medication under medical supervision. Diagnostics showed elevated blood pressure but no other abnormalities. Her admitting diagnosis was hypertensive urgency.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    56 views57 pages

    Hypertension CASE REPORT

    Uploaded by

    Julienne Sanchez-Salazar
    This case presents a 54-year-old Filipino woman who presented with dizziness and nausea. Her blood pressure was elevated at 200/120. She has a history of hypertension for 15 years but is non-compliant with her Losartan medication. Differential diagnoses considered include benign paroxysmal positional vertigo and hypertensive urgency. She was admitted for management of her hypertensive urgency, including restarting her antihypertensive medication under medical supervision. Diagnostics showed elevated blood pressure but no other abnormalities. Her admitting diagnosis was hypertensive urgency.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 57

    Case Presentation

    SANCHEZ, Julienne Rowelie A.


    AUP Clinical Clerk ‘19
    General Objectives:
    To present the case of a patient suffering from
    Hypertensive Urgency
     
    Specific Objectives:
     To define hypertension
     To differentiate between hypertensive urgency
    and emergency
     To determine the appropriate diagnostics and
    management of hypertension
    Demographics
    • E.A.B
    • 54 year old Female
    • Filipino
    • Widow
    • SDA
    • Born on January 4, 1965
    • Carlos, Pandacan, Manila
    • First time to seek consult in our
    institution – March 23, 2019
    Dizziness

    Chief Complaint
    History of Present Illness
    Few hours PTA

    • Dizziness- Non-rotatory, consistent


    • (+) Nausea, (-) Vomiting episodes
    • No headache, nape pain, chest
    Consult
    • Patient was apparently well. pain, slurring of speech, blurring of
    vision, loss of consciousness, body
    weakness
    • BP: 200/120
    • Took Losartan 50mg
    • No relief
    (+) HTN x 15 years – Losartan 50mg at AM
    Non-compliant; HBP: 140/90, UBP: 120/80 (+) Hypertension - Father
    Place Your Picture Here
    No DM, Heart Disease, Asthma, PTB, COPD, No known family history of Heart Diseases,
    Cancer Asthma, Pulmonary Tuberculosis, Thyroids
    No known allergies to food and drugs. disease, Stroke and Renal Diseases.
    No previous hospitalizations
    and surgeries.

    Housewife, currently living with children


    Widowed
    LMP: Menopause
    No food preference, no diet restrictions
    G4P2(2022) via CS (+) Occasional alcoholic beverage
    drinker
    Non-smoker
    (-) Weight change, Fatigue,
    Easy fatigability, Chills, Loss of
    Appetite
    (-) hematemesis, no dysphagia,
    no heartburn, no abdominal
    pain, no change in bowel
    (-) Rashes, pruritus, habits, no diarrhea, no
    discoloration constipation, no melena, no
    hematochezia

    (-) discharges, no pruritus, no


    (-) headache, vision changes, dysuria, no frequency
    dysphagia, colds

    (-) seizures, no loss of


    (-) cough, DOB, Hemoptysis consciousness, no change of
    behavior, no body weakness.

    (-) Chest pain, palpitations


    PHYSICAL
    Patient is awake, conscious,
    EXAMINATION coherent, ambulatory, and not in
    GENERAL SURVEY
    cardiorespiratory distress.

    She is of average body built and


    height, well groomed.
    PHYSICAL
    Vital signs
    EXAMINATION BP: 140/90 HR: 63 bpm RR: 16 cpm
    VITAL SIGNS
    T: 36. 1 C O2 sat: 98%

    Height: 160 cm Wt: 51.7 kg


    BMI: 20.19 kg/m2
    PHYSICAL
    EXAMINATION
    SKIN No pallor, no cyanosis, no
    rashes, no lesions, good skin
    turgor
    Head - Skull is normocephalic. Hair
    PHYSICAL distribution normal and with average
    texture.
    EXAMINATION Eyes - Anicteric sclerae, pink palpebral
    HEENT conjunctiva. No conjunctival injections;
    Ears – bilaterally symmetrical, non-tender,
    no lesions, no foul smelling, no discharges.
    Throat – moist oral mucaosa, pinkish
    pharynx without exudates and non-
    enlarged tonsils with good dentition.
    Tongue midline.
    PHYSICAL
    EXAMINATION No visible neck masses, non-
    NECK
    distended neck veins, Supple, no
    cervical lymphadenopathies No
    palpable masses
    No lesions, symmetrical chest
    PHYSICAL expansion, good inspiratory effort,
    tactile fremitus present and
    EXAMINATION bilaterally equal.
    CHEST/ LUNGS
    Lungs are resonant upon percussion
    on all lung fields.

    Breath sounds vesicular; no rales,


    crackles, wheezes or rhonchi. No
    adventitious breath sounds.
    PHYSICAL No deformities, adynamic
    precordium, No heaves, thrills, and
    EXAMINATION lifts noted. PMI best at 5th
    HEART
    intercostal space, midclavicular line.
    Normal rate with regular rhythm. At
    the base, S2 is greater than S1. At the
    apex, S1 is greater than S2.
    No murmurs.
    PHYSICAL
    Flabby, nondistended, normoactive
    EXAMINATION bowel sounds, tympanitic on all
    ABDOMEN
    quadrants, Soft without direct and
    rebound tenderness, no palpable
    masses and organomegaly noted.
    No CVA tenderness.
    PHYSICAL
    EXAMINATION No edema, no clubbing of the digits,
    MUSCULOSKELETAL &
    EXTREMITIES full and equal pulses, Capillary Refill
    <2 seconds. Full range of motions in
    all extremities.
    Salient Features

     54 year old Female


     Diagnosed Hypertensive 15 years PTA
     Was prescribed with Losartan 50mg OD- Noncompliant.
     Non-rotatory dizziness
     Nausea
     BP 200/120
    Your Picture Here

    Differential Diagnosis of
    Dizziness
    BPPV
    Your Picture Here RULE IN RULE OUT
    (+) Dizziness (-) Vertigo, precipitated by rapid
    Age – 54 years old change of head positions or
    (+) Nausea posture(turn from side-side);
    (-) Wax-wane pattern.
    (-) Torsional nystagmus
    (-) Confirmed by Dix-Hallpike
    test
    Hypertensive Emergency
    RULE IN RULE OUT
    (+) BP: 200/120 (-) headache, nape pain, chest
    (+) Nausea pain, slurring of speech, blurring
    (+) Noncompliant to of vision, loss of consciousness,
    medications body weakness, dysuria, oliguria

    Hypertensive Urgency
    RULE IN RULE OUT
    (+) BP: 200/120 Cannot totally rule out
    (+) Nausea
    (+) Noncompliant to
    medications
    Hypertensive urgency
    ADMITTING DIAGNOSIS
    Admitting Orders
    • Admit under the service of Dr. Varona
    • Secure consent to care and management
    • VS q4, I & O q shift
    • Diet: Low salt, Low fat
    • IVF: PNSS 1L x 80 cc/hr
    • Diagnostics:
    CBC, Na, K, LP, FBS, Crea, ALT, Trop I, CBG
    CXR PA/L, CG 12L, UA, BUA
    • Therapeutics:
    1. Losartan 50mg/tab, 1 tab OD
    2. Esomeprazole 40mg IV OD Pre-meals
    3. Betahistine 16mg/tab, 1 tab TID
    • Dr. Varona updated
    • Refer accordingly
    Diagnostics
    CBC
    Hgb 131
    Hct 0.41 Trop I 0.010
    WBC 6.10
    Segmenters 72
    Lymphocytes 19
    Platelets 276

    UA
    SGPT 20 SG 1.010
    Creatinine 65 pH 7
    BUA 315 wbc 0
    Na 142 rbc 1
    K 4 Bacteria 119
    MT 3
    Hypertensive Urgency
    Hypertension
    • Blood pressure of 130/90
    • Based on an average of a 2
    careful readings obtained on
    >2/= occasions

    2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
    Epidemiology

    • According to the latest WHO data published in 2017


    Hypertension Deaths in Philippines reached 14,751 or
    2.38% of total deaths.
    • 8th leading. cause of death in the Ph
    • Ph ranks 44th in the world

    2017 WHO
    Epidemiology

    • Early Adulthood- Men


    • 60 years and older- Women
    • Diastolic blood pressure increases progressively with age
    until ∼55 years, after which it tends to decrease

    pp. 1611, Harrison’s Principles of Internal Medicine 19th edition


    Risk Factors

    • Obesity and weight gain


    • High NaCl intake
    • Low dietary intakes of calcium and potassium
    • Alcohol consumption
    • Psychosocial stress
    • Low levels of physical activity

    pp. 1612, Harrison’s Principles of Internal Medicine 19th edition


    Mechanisms of Hypertension

    • Intravascular Volume
    • Autonomic Nervous System
    • RAAS
    • Vascular mechanisms

    Harrison’s Principles of Internal Medicine 19th edition, pp 1612


    Intravascular Volume
    Autonomic Nervous System
    Vascular mechanisms
    Categories of Hypertension

    2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
    Clinical Disorders of Hypertension

    • Primary “Essential” Hypertension


    • Secondary Hypertension

    Harrison’s Principles of Internal Medicine 19th edition, pp


    Harrison’s Principles of Internal Medicine 19th edition, pp
    Screening

    2017 ACC/AHA Guideline for the Prevention, Detection,


    Evaluation, and Management of High Blood Pressure in Adults
    Screening

    2017 ACC/AHA Guideline for the Prevention, Detection,


    Evaluation, and Management of High Blood Pressure in Adults
    Screening

    2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
    Diagnostics

    2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
    Management

    2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
    2017 ACC/AHA Guideline for the Prevention, Detection,
    Evaluation, and Management of High Blood Pressure in Adults
    Hypertensive
    Urgency vs.
    Emergency

    2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
    2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
    2017 ACC/AHA Guideline for the Prevention, Detection,
    Evaluation, and Management of High Blood Pressure in
    Adults
    2017 ACC/AHA Guideline for
    the Prevention, Detection,
    Evaluation, and
    Management of High Blood
    Pressure in Adults
    2017 ACC/AHA Guideline for
    the Prevention, Detection,
    Evaluation, and
    Management of High Blood
    Pressure in Adults
    Resources:

    2017 ACC/AHA Guideline for the Prevention, Detection,


    Evaluation, and Management of High Blood Pressure in Adults

    Harrison’s Principles of Internal Medicine 19th edition, pp 1612

    2017, Hypertension update, JNC8 and beyond;


    Current Opinion in Pharmacology
    Thank you!

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