Patient with severe hypertension | Figure 1

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Patient with severe hypertension

A 55 year old man comes to see the first time for review of his blood pressure. His BMI is 28. He claims to have no other known medical history of note. He is currently on losartan 50mg daily, atenolol 50mg daily and amlodipine 5mg daily dosage. I have measured his BP in the clinic 30 minutes apart and the readings are 192/113 mmHg and 187/111 mmHg respectively. The patient is otherwise asymptomatic with normal chest auscultation. His optic appears normal on inspection. Which of the following is the LEAST APPROPRIATE next step?

A. A short acting anti hypertensive medication like captopril should be given to the patient to bring down the blood pressure within 12-24 hours

B. The patient should be screened for hyperlipidaemia and diabetes

C. Do thyroid function test and do a more detailed history taking to exclude OSA

D. Replace atenolol with hydrochlorothiazide and check the BP again in 1 week

E. Advise the patient to do home BP monitoring in the morning and evening over the next 1 week and check the average of the readings

35-year-old male with hypertension, diabetes, hyperlipidemia.

The patient was diagnosed with hypertension at 34 years of age and is on losartan and metoprolol and states that he is compliant with his medication including taking his medications today. He states he went to his primary care physician for routine visit and his blood pressure was noted to be elevated of greater than 250 once to the emergency room. The patient otherwise has no symptoms. He states he has been urinating normally with no chest pain, no shortness of breath, no headache, no visual changes, no neurologic symptoms including confusion. In the emergency room, his initial blood pressures 250/159. His creatinine is 6.3. Troponin 0.8 without increasing trend. He denies tobacco or alcohol use. Paternal side has hypertension and diabetes. Echo was normal. Think he’s having hypertension from worsening renal failure?

26 year old male

who has a BMI OF 52.88, no past Medical significant history. Who present to Clinic with elevated BP of 178/100 when rechecked 138/85. Complains of no symptoms but work stress. He does smoke 1 cigarette a day-borrowing from others, but used to smoke more. He came into just do a BP Check today and it read 178/100. Rechecked it 155/88. I did not start him on anything yet because I feel weight loss will help him. Told patient to keep food log and check BP x 2 weeks again and return. The whole thing with him is should I start BP low dose med on him. He’s very young and weight loss can help.

Home measurement with a verified Blood pressure meter. (Reads the same as the office readings when the patient is at the office.) ever see "White coat hypertension " this exciting?

A man in his early forties, BMI-43, blood pressure 168/110, vital signs otherwise normal; no past medical or surgical history, father and mother succumb to chronic diseases related to high blood pressure and diabetes; he comes to you for his initial health assessment!

A 52-year-old man

presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?