Question

A 56 year old female with no significant past medical history presented to the emergency after being seen at the optimetrist for the complain of blurred vision and was found to have markedly elevated blood pressure. She reported wavy vision from the left eye as well as decreased peripheral vision and decreased color vision. She noted 3 episodes of left sided headaches over the last month, but has otherwise felt well. She reported no chronic medication and substance abuse. Family history was significant for a brother with diabetes. Review of system was negative aside from the above mentioned visual changes. She reported no chest pain, no shortness of breath, no abdominal complaints or urinary complaints. Physical exam was significant for the severe hypertension with bp of 245/115. Otherwise her exam was unremarkable. A report from optometry clinic noted that she has retinal changes. What should be the more likely diagnosis of patient according to her condition? How can be manage her condition?

Answer 1

• Normal blood pressure is represented by 120/80. The upper value of 120 mm Hg represents systolic pressure, the lower value 80 represents diastolic pressure.
• Thus, 245/115 represent high blood pressure.
• Acute rise in blood pressure may cause rupture or narrowing of blood vessels supplying brain.
• This may lead to headache (as indicated by episodes of left sided headaches).
• The blood vessels supplying to retina may be also damaged or significantly narrowed causing decreased retinal function.
• Optic nerve may be affected, (like swelling) causing impaired vision (wavy lines, decreased color vision).
• High blood pressure thus can lead to hypersensitive retinopathy.

Condition may be managed by:

• Medical aid doctor consultaion.

• Regular monitoring of vital signs.

• At low or moderate rate atropine has to effect on vasoconstriction or have no effect on constriction (or relaxation/ vasodilation), thus having to effect on blood pressure.

• Natriuretic peptides can increase excretion of sodium and increases the extracellular fluid. This results in decrease in blood pressure.

• Avoiding stressful stimuli.

• Abstaining from alcohol consumption and smoking.

• Decrease caffeine consumption.

• Regular exercise.