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| Signs and Symptoms – Common presentation | How does the diagnosis impact each body system? Complications? |
| Hypertension is a silent disease. It is often reported as an accidental finding during clinical visitation in primary healthcare (Gabb, 2020). People with the disease may, however, manifest with severe headaches, chest pains, difficulty breathing, dizziness, blurred vision, nausea, and vomiting. | If left unmanaged, hypertension may have significant impacts on various organs. In the central nervous system, hypertension is a risk factor for cerebrovascular accidents. It is a leading cause of stroke (Yu et al., 2023). In the renal system, hypertension can result in chronic kidney disease and, eventually, kidney failure. In the cardiovascular system, uncontrolled hypertension can result in left ventricular hypertrophy and, subsequently, heart failure. Hypertension can also cause visual loss (Yu et al., 2023). |
What is another potential diagnosis that presents in a similar way to this diagnosis (differentials)?
| Hyperaldosteronism, aortic valve disease, renal artery stenosis, and chronic kidney disease are some of the differential diagnoses in the assessment of hypertension. These conditions are often implicated as factors in secondary hypertension and usually present with symptoms similar to those seen in the primary disease. |
What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?
| Blood pressure measurements are the only sure way of diagnosing the disease. According to the American College of Cardiology, at least two office measurements on two separate occasions are necessary to diagnose the disease. Other diagnostic tests may be required to assess the signs of end-organ damage. These include fundoscopy for retinopathy, 12 lead electrocardiograms to assess left ventricular hypertrophy, a blood workup to assess an underlying disease, and an Ankle-brachial pressure index to assess peripheral artery disease. Imaging may be necessary when deemed feasible. |
What treatment options would you consider? Include possible referrals and medications.
| Comprehensive management of hypertension utilizes pharmacological and non-pharmacological interventions. Non-pharmacological approaches are centered on diet and physical activity. Restriction of salt intake and exercise have been shown to optimize blood pressure control. They are part of the first line management of the disease in mild disease. As part of patient education at the point of care, detailed instruction on dietary salt restriction, reduction in alcohol consumption, smoking cessation, exercise, adequate sleep, and weight management should be given to the patients (Carey et al., 2021). The pharmacological approach utilizes antihypertensive medications. These include angiotensin-converting enzyme inhibitors such as enalapril, angiotensin receptor blockers such as losartan, diuretics such as thiazide, beta-blockers such as metoprolol, and calcium channel blockers such as amlodipine.
A referral may be necessary if an underlying cause is established. |
Carey, R. M., Wright, J. T., Taler, S. J., & Whelton, P. K. (2021). Guideline-driven management of hypertension. Circulation Research, 128(7), 827–846. https://doi.org/10.1161/circresaha.121.318083
Gabb, G. (2020). What is hypertension? Australian Prescriber, 43(4), 108–109.
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