General

Management of Hypertension

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27 Aug 2016 - General
 

48 years old gentleman, with background of previous appendicectomy, smoker of 20/day for 20 years, and increased body mass index, attended GP practice for viral upper respiratory tract infection. He has not been seeing a doctor for the last 28 years. When checking his blood pressure,GP noted that his blood pressure was elevated to around 168/95, with a regular pulse of around 75 per minute. He denies any headache, chest pain, shortness of breath or palpitaion. He never know that his blood pressure was high before. He claims that he has no problem with such a high blood pressure as he has no any symptoms of it. He is having a sedentaryme lifestyle as well. What will be your management strategy or plan of actions for this gentleman ??

Once a diagnosis of hypertension is confirmed for this patient, I will request basic ancillary tests that will rule out secondary causes of hypertension. (hyperthyroidism, renal causes etc.) Although he definitely has risk factors for developing essential hypertension, it is still important to consider treatable causes of hypertension especially if this patient was never worked up before and the history is not helpful. Here are tests that I will request: Chest xray, ECG, 2d-Echo (this will give ...
 (Total 128 words)
Basing on the datas that you have given; as a nurse usually, we let the patient lie down in high fowlers/ high back position. In our hospital, the doctor will order a medication given sublingually and we will be monitoring the bp of the patient closely. Once the bp is above normal, the doctor will prescribe a maintenance medication and as well as the doctor will request for the blood work out. Our task is to encourage/teach the patient the importance of exercise, food/diet restrictions most espe...
 (Total 108 words)
The first thing to do is lead the gentleman to a quiet room. Let him lie down with the head elevated. If he becomes symptomatic or if BP does not lower after 30 minutes, a sublingual BP lowering medication may be given. In the Philippines, it is not common practice to give the sublingual medication immediately for asymptomatic patients due to possibility of rebound hypertension. The documeneted blood pressure falls under the JCS category of stage 2 hypertension. He must be started on a calcium-c...
 (Total 159 words)