High Blood Pressure

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Returns for a hypertension follow-up

Last visit was ‍ ‍months ago

Blood pressure monitoring: ‍ ‍not monitored (target ‍135/85)



Current symptoms: ‍none

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍shortness of breath

‍palpitations

‍dizziness

‍blurred vision

‍fatigue

‍confusion



Medications:

‍ACEI, ‍ARBs, ‍Beta blockers, ‍Calcium channel blockers, ‍Diuretics, ‍Others, ‍combinations

‍NSAIDs, ‍oral steroids

Adherence: ‍goodaveragepoor, ‍adverse effects

Over-the-counter supplements: ‍ ‍none



Social history:

Smoking: ‍neversmokerformer smoker, ‍ pack-years

Alcohol: ‍nonesociallyexcessive, ‍ drinks per ‍dayweek

Recreational drugs: ‍none ‍cannabis, ‍IVDU

Caffeine: ‍ daily

Diet: ‍goodaveragepoor, ‍high in salt, ‍high in carbs, ‍high in fat, ‍vegan

Physical activity: ‍adequateaveragesedentary

Weight: ‍ ‍lbskg, ‍gainunchangedloss



Labs: ‍unremarkable

Creatinine: ‍ ‍normal

Na: ‍ ‍normal, K: ‍ ‍normal

Hb: ‍ ‍normal

HbA1c: ‍% ‍normal

Lipids: ‍normal, Cholesterol: ‍, LDL: ‍, HDL: ‍, Triglycerides: ‍

TSH: ‍ ‍normal

Urinalysis: ‍ ‍normalproteins





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Metrics: weight: ‍ ‍kglbs, height: ‍ cm, waist: ‍ cm, BMI: ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady





ASSESSMENT:

‍Hypertension ‍likelysuspectedpossible, ‍well-controlled

DDx: essential hypertension, secondary hypertension, white coat hypertension, renal artery stenosis, chronic kidney disease, primary aldosteronism, Cushing's syndrome, pheochromocytoma, coarctation of the aorta, thyroid/parathyroid disease, sleep apnea, medication-induced hypertension, pregnancy-induced hypertension, preeclampsia, drug abuse (e.g., cocaine, amphetamines), alcohol-induced hypertension





PLAN:

Investigations:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍HbA1c, ‍lipid profil, ‍TSH

- Urinalysis

- ECG if new onset

- Home blood pressure monitoring

Treatments:

- Lifestyle counseling: ‍sodium restriction, ‍DASH diet, ‍increase exercise, ‍weight loss

- ‍ACEs

- ‍ARBs

- ‍Beta-blockers

- ‍Calcium-channel blockers

- ‍Diuretics

- ‍Others anti-hypertensives

Further care:

- Referral to dietitian

- Follow-up in ‍ months

- Return if blood pressure is above target