Amal is a 50-years-old previously healthy woman presented two weeks earlier to the Emergency Department with a three days history of flu-like symptoms with headache and running nose not relieved by over-the-counter medications. On examination her BP readings were repeatedly around 160/95. She was discharged home given appropriate treatment for her flu, and referred to the hypertension clinic for further assessment and management of her high blood pressure. Today at the clinic the patient is still complaining of disturbing headaches, and she admitted experiencing excessive hotness and occasional palpitations. Repeated clinic BP readings are around 135/80.
What are the possibilities? How we approach this patient scenario?
First question: Is this patient hypertensive or not?
To diagnose hypertension we need evidence of long standing high blood pressure readings (multiple readings in more than two sessions), or evidence of hypertensive end-organ damage.
The patient is complaining of symptoms that may or may not be related to her high blood pressure readings and need explanation.
Second question: What is its cause?
If the patient is hypertensive, what could be the cause, taking in account that 90% of hypertension is primary without a definitive cause?
Third question: what is the stage of hypertension, and what are its complications?
Fourth question: What is the cardiovascular risk assessment for this patient, and what other co-morbidity she has?
The following figure summarizes reasonable possibilities:
Amal is diagnosed as primary hypertension, with typical side effects of calcium channel blocker (nifidipine) prescribed when visited the Emergency Department (headache, palpitation, facial hotness and flushing).