Castro, Justin Gerard C.

10/14/14
SGD #3

1.) What are the salient features of this case?
Subjective: History of hypertension, Nape pain and headache, history of DM, Polyuria,
polyphagia, polydypsia, Bubbly urine, (+) FH for HPN and DM, Smoker (30 pack years),
occasional alcoholic beverage drinker

Objective: BP 210/120, Apex beat at 6
th
LICS AAL sustained and diffused and a grade 3/6 early
systolic murmur at the apex, Central obesity with waist circumference of 110cm, 2/5 MMT Right
upper and lower extremities with right facial assymtery.

2.) Compute for the Patients BMI:
BMI is 33. Patient is in obese class 1 category.

3.) Discuss BMI classification based on WHO.



4.) Is this a case of Hypertensive emergency or urgency?
- This is a case of hypertensive emergency since there is already an elevation of blood
pressure greater than 180/120 and it is also complicated by the evidence of impending or
progressive target organ dysfunction.

5.) What are the possible target organ damage that could be present in hypertensive emergency
and if which among these were present in the patient if theres any?

- Kidneys (impaired renal function, hematuria)
- Eyes (Papilladema, retinal hemorrhages)
- Heart (Left ventricular Hypertrophy, Coronary Heart diseases)
- Brain (Encephalopathy)
- Arteries (Stroke, Aortic dissection, intravascular coagulation)

- There could be a neurologic impairment since patient experienced right upper extremity
weakness with slurring of speech.
- Possible Renal disease due to (+) Bubbly urine which can indicate Protenuria
- There is enlargement of the heart, Apex beat is palpable at the 6
th
LICS AAL with sustained
and diffuse beat
6.) What are the cardiovascular risk factors and identify which among the risk factors are present in
the patient.


Blood pressure: 210/120
Diabetes Mellitus
Family History of Hypertension and DM
Age of 59years old
Obesity with BMI of 33
Occasional alcohol drinker

7.) What laboratory test or ancillary will you request to for the patient?
- I would request for Lipid Profile complete with HDL, LDL, Total Cholesterol and Triglyceride
levels, Routine Urinalysis to rule out Renal damage, Chest X ray to detect Cardiac
Enlargement, 2D echo to detect concentric LV hypertrophy, Fasting Blood Glucose to detect
if patients blood sugar is controlled or not.





8.) How do you manage hypertensive emergency vs hypertensive urgency?

-


9.) What is the recommended drug of choice for this patient?

- If the patient has hypertensive encephalopathy or pulmonary edema, and if
arterial pressure must be reduced rapidly immediate-acting drug.
Furosemide orally or IV (adjunct): maintains Na diuresis in the face of a arterial pressure
speed up recovery from encephalopathy & CHF; maintain the sensitivity to the primary anti-
HPN drug.
Digitalis: if there is evidence of cardiac
decompensation.




10.) Discuss algorithm for treatment of Hypertension.


11.) Discuss the recommendation for management of Hypertension in JNC 8.


12.) What are the possible complications of hypertension if left untreated?
- Heart failure:
myocardial damage (mediated by aldosterone in the presence of a normal/high salt intake)
congestive heart failure (ischemia, infarction in late disease)
Kidney failure:
arteriosclerotic lesions of the afferent and efferent arterioles & glomerular capillary tufts
form GFR & tubular dysfunction
10% of the deaths caused by hypertension result in renal failure

13.) What metabolic syndrome is present in the patient?
- Yes! Presence of Central Obesity, Blood pressure of 210/120, and a BMI of 33

14.) How do you manage the patients metabolic syndrome?
- Diet: Decrease intake of simple sugars
- Weight loss and exercise is necessary
- Decrease LDL via HMG coa reductase inhibitors or statins
- Fibric Acid derivatives or fibrates
- Omega 3 fatty acids
- Metformin is the drug of choice for the patients DM since the patient is obese.