Question

JP a 57-year-old account executive presents for blood pressure follow-up visit

Elevated blood pressure identified 2 months ago during annual exam 164./ 86; 170/ 100

Interim blood pressure taken at local pharmacies have all been normal 129/ 82

Normal hematology, biochemistry, renal function and electrolytes

Normal EKG with no evidence of LVH

Office blood pressure( using auscultatory wall-mounted mercury sphygmomanometer):

152/102 mmHg

How would you explain this observation?

DESIGN A TREATMENT PLAN with rationales

Answer 1

This seams to be a case of office hypertension. This situation happens when the patient shows high Blood Pressure in doctor's office and shows normal Blood Pressure during rest of the time. In this case also JP showed elevate blood pressure during annual check-up and auscultatory wall-mounted mercury sphygmomanometer measurement while showed normal BP level at local pharmacies. This condition is also called white coat hypertension since the doctors usually wear white attire.

Though there is no definite treatment plan for this problem but it has been found that people with this problem have higher chance of developing high blood pressure condition in the future. To avoid that condition, time to time measurement of Blood Pressure level in different settings is advisable to keep a track on the BP. Patient should have more of fruits, vegetables, whole grains and other low fat food. Potassium is one thing that controls Blood Pressure to great level. So, more of potassium reach food items should be included in the diet. Salt and caffeine plays a crucial role in elevating the BP level in the body. So, food item with a lot of salf and caffeine must be avoided.