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Hypertension

My patient's BP ranged from 149/86 to 128/78 during hospital stay.
             Signs and Symptoms: Many people who are hypertensive have no symptoms. Symptoms that may accompany hypertension include occipital headaches that are more severe on arising, lightheadedness, and epistaxis (nosebleed). If hypertension has damaged blood vessels in the heart, kidneys, eyes, or brain, the patient may have symptoms of impaired function of those organs. My patient has no symptoms.
             Diagnosis: Diagnosis of hypertension is based on direct and indirect data. Hypertension is confirmed by averaging two or more blood pressure measurements on two or more occasions and finding the averages above 140/90. On finding an elevated blood pressure, the physician examines the patient for effects of hypertension on other parts of the body. An eye examination with an ophthalmoscope may reveal retinal hemorrhages or narrowed retinal arteries. An electrocardiogram may reveal left ventricular hypertrophy or myocardial ischemia. Blood samples are usually drawn for a complete blood count and assessment of liver and kidney function. If there is kidney damage, the blood urea nitrogen and serum creatinine levels are elevated. Elevated serum cholesterol may indicate atherosclerosis. A chest radiograph may show enlargement of the heart or pulmonary blood vessels. Physicians disagree about the need for trying to determine the cause of hypertension. If there is no evidence to suggest an underlying disease process, the general consensus is to limit diagnostic tests to those that are most significant. This reduces patient care costs. My patient had no tests to diagnose his hypertension.
             Medical Treatment: The goal of therapy for hypertension is gradually to reduce peripheral vascular resistance and blood pressure. Optimal blood pressure is usually defines as a diastolic pressure of less than 85 mm Hg. Treatment of underlying conditions may lower the blood pressure in people with secondary hypertension.


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