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I would also caution you about this circumstance being particularly common in hospitalized patient’s. Just because somebody is in the hospital to have a GYN procedure, very often patient’s will have mild elevations in their blood pressure, please don’t jump to the conclusion that they have sustained elevations in their pressure if they have not had multiple recorded pressures that are elevated.
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Once you have decided that the patient does indeed have multiple readings over 140 or over 90 and that the do have confirmed hypertension, you have through history and physical and a very small set of laboratories, you need to answer three question; does the patient have primary, essential or doctor not smart enough to understand why hypertension, which will be every case in your entire career, save a few, or does the patient have some sort of secondary cause of hypertension, or what internists like to talk about, things like pheochromocytoma, there are a few important things you need to understand for secondary causes. Oral contraceptives are an important cause of secondary hypertension as is large amounts of alcohol intake and less frequently underlying renal disease. I am not going to ask you to think about any weird endocrinopathies, you don’t need to think about those disorders because you will never really see them. If patient’s have symptoms that you think are compatible with a pheochromocytoma , wild fluctuations in their blood pressure, severe unrelenting headaches, unexpected bouts of palpitations and anxiety, that is a patient you might want to refer for workup. It will be a very rare circumstance. The second question you need to answer with a targeted history, exam and laboratory is, does the patient have target organ disease, have they had a stroke, do they have coronary artery disease, or heart failure, or do they have renal insufficiency, easy to answer, and finally there are other cardiovascular disease factors present.

This entry was posted on Thursday, December 3rd, 2009 at 1:44 pm and is filed under Hyperstension. You can follow any comments to this post through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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