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A Case of Hypertension

A Case of Hypertension. Dr. Susan Poe, case presentation Dr. Paul Kellerman, topic discussion October 10, 2007. No financial incentives. Case.

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A Case of Hypertension

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  1. A Case of Hypertension Dr. Susan Poe, case presentation Dr. Paul Kellerman, topic discussion October 10, 2007

  2. No financial incentives

  3. Case • JM is a 73 yo white widowed woman presenting with long standing hypertension. She was diagnosed with hypertension at age 35 and has been on a variety of medications since that time. • Previous meds include: HCTZ, atenolol, dyazide, lisinopril, losartan, and verapamil. Most recently verapamil and HCTZ/triameterene. • BP controlled has fluctuated but overall has been suboptimal.

  4. Case continued.. • Pt c/o chronic fatigue and nonspecific aches and pains. No cardiovascular c/o. • Recently completed 1 year course of ribavarin and interferon for Hep C • Developed hypothyroidism during above treatment , now controlled.

  5. PMH • Hepatitis C with stage III fibrosis diagnosed 1995, treated with interferon 1995 and combination ribavirin and interferon until 4/05-3/06. • Hypothyroidism- onset during above course • Atrial fibrillation 1992 and 7/06 during acute illness • Recurrent diverticulitis • Osteopenia • GI bleed presumed secondary to diverticulosis • Drug induced lupus • Elevated ANA • Asthma • TAH/BSO

  6. Medications • Verapamil 360 mg qd • Maxide 37.5/50 mg qd • Synthroid 25 mcg qd • MVI

  7. Social History • Widowed, retired nurse • Lives alone • 3 grown children, all with htn • Minimal alcohol • Nonsmoker

  8. Physical Exam • BP 160/80, HR 68, wt 125 • Pleasant, no distress • HEENT: no thyromegaly or lymph nodes • Chest clear to A and P • CV RRR no murmur, gallop or rub • ABD soft nontender no organomegaly or masses. No abdominal bruits • EXT no edema. Normal pulses • Neuro grossly intact

  9. Routine labs • CBC: Hct 34, WBC 6.5 • Sodium 138 • Potassium 3.4 (previous 3.5, 3.6, 3.8) • BUN/Cr 22/ 1.1 • Glucose 90 • LFTs nl • TSH 3.23

  10. Abdominal CT…. • Abd CT performed in ER 8/06 when presented with abdominal pain • Incidental bilateral adrenal hyperplasia

  11. Further labs:… • Renin 0.6 • Aldosterone 25 • Aldosterone/ PRA ratio > 40

  12. Treatment…. • Started spironolactone 50 mg qd and referred to hypertension clinic

  13. Next few BP’s 132/68, 152/64, 146/66 • Increased spironolactone to 50 mg bid • BP’s 142/74, 136/68, 134/62, 150/80, 130/64, 118/70

  14. BP before and after spironolactone • Average BP before 150/76 • Average BP after 139/69 • Referred to HTN clinic

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