Question

Design a case study with hypertension, pathophysiologic concepts to your chosen disease process. Your case study should include the following elements:

1. Patient age

2. Past medical history

3. Any medications they are taking

4. Vital signs

5. Presentation (also described as the “chief complaint” or “history of present illness”)

6. Diagnostic values (such as laboratory or radiologic findings)

Include only relevant data--it should not be your goal to “fool” someone with an unnecessarily complex or confusing case, but rather provide an opportunity for practical application of new information.

  

You should include at least 4 questions for consideration in your case study. Focus your questions on interpreting the clinical scenario. For example, you may ask about the significance of a clinical finding or about the significance of a part of the medical history.

Answer 1

A 62 year old African-American woman with prediabetes presents for her annual physical. She has no complaints. The average of 2 BP readings in her right arm is BP 230/120 mm Hg. Her physical exa m is unremarkable except for obesity. She has no history of myocardial infarction, stroke, kidney disease, or heart failure. Her vitals were

Pulse 78b/Min

RR- 18/min

BP - 230/120 mm Hg

SPO2 - 99%

Hematocrit was 38%; serum sodium, 140 mEq/L; and serum potassium, 2.7 mEq/L. His medications included propranolol and hydrochlorothiazide.

Her total cholesterol is 260 mg/dL, HDL 42 mg/dL, and LDL 165 mg/dL. Renal parameters were eithin limits. She does not smoke.

After the visit, she measures her BP at home and returns 1 month later. The average BP from multiple clinic and home readings is 138/86.

1. Define hypertension and classify its severity. True systemic hypertension can be diagnosed when there is an increase in arterial pressure above accepted normal pressure for age, sex, and race. The accepted upper limits of normal BP are as follows: Adult 140/90 mm Hg Adolescent 100/75 mm Hg Early childhood 85/55 mm Hg Infant 70/45 mm Hg The accepted upper limit of normal pressure in the adult was chosen as 140/90 mm Hg rather than 160/95 mm Hg (World Health Organization criteria) because systolic BP levels above 140 mm Hg and diastolic levels above 90 mm Hg are associated with increased risk for eventual cardiovascular disease. 2. What is the prevalence of hypertension? The prevalence of hypertension depends on both the racial composition of the population and the criteria used to define hypertension. In a white suburban population like that in the Framingham Study, nearly one fifth have BPs greater than 160/95 mm Hg, and almost one half have BPs greater than 140/90 mm Hg. A higher prevalence has been found in the nonwhite population. The frequency increases with the age of the population. The number of hypertensive persons in the United States in 1983 was estimated to be 57.7 million—more than double the estimate made in 1960 to 1962. .3. What is the general classification of hypertension? Enumerate the causes of each type of hypertension. The classification is outlined in above table Systolic and Diastolic Hypertension Essential hypertension Unknown etiology Renal Acute and chronic glomerulonephritis, chronic pyelonephritis, polycystic kidney, diabetic nephropathy, hydronephrosis, renovascular stenosis, renin-producing tumors, primary sodium retention Endocrine Adrenal: Cushing's syndrome, primary aldosteronism, congenital adrenal hyperplasia, pheochromocytoma, acromegaly, hypothyroidism, carcinoid, hyperthyroidism, oral contraceptives, corticosteroids Neurogenic Psychogenic, increased intracranial pressure, spinal cord section, familial dysautonomia, lead poisoning, Guillain–Barré syndrome, sleep apnea Miscellaneous Coarctation of aorta, increased intravascular volume, pregnancy-induced hypertension, polyarteritis nodosa, acute porphyria, hypercalcemia, alcohol and drug use, acute stress including surgery Systolic Hypertension with Wide Pulse Pressure Arteriosclerosis, rigidity of aorta Increased cardiac output Arteriovenous fistula, thyrotoxicosis, patent ductus arteriosus, beriberi heart, fever, aortic valvular insufficiency .4. What are the usually clinical patterns of hypertension encountered? "Vasoconstricted" hypertension—in medical patient with chronic renovascular hypertension, characterized by diastolic hypertension and systemic vascular resistant with normal or even decreased cardiac output and heart rate. "Hyperdynamic" hypertension—in postoperative surgical patient, characterized by acute systolic hypertension; widened pulse pressure; and increased cardiac output, heart rate, and systemic vascular resistant.