[Basic Information] Male, 40 years old
[Disease Type] Hypertension, Grade 3 Hypertension｜Severe Hypertension
[Diagnosis time] August 2020
[Treatment hospital] Peking University People’s Hospital
[Treatment plan] Irbesartan Hydrochlorothiazide Tablets, Felodipine Extended Release Tablets, Atorvastatin Calcium Tablets, Sodium Bicarbonate, Allopurinol
【Treatment period】3 months
【Treatment effect】Recovering
【Reason for sharing】High blood pressure as an influence It is an independent risk factor for the occurrence and prognosis of cardiovascular events, but it is not the only determinant. Most hypertensive patients also have cardiovascular risk factors other than elevated blood pressure, such as hyperlipidemia and diabetes. Therefore, the diagnosis and treatment of hypertensive patients cannot be based solely on the blood pressure level, and the comprehensive cardiovascular risk assessment and stratification of the patients must be carried out, so as to more accurately determine the timing of starting antihypertensive treatment, optimize the antihypertensive treatment plan, and establish a more Appropriate blood pressure control goals and individualized comprehensive management.
I. First acquaintance with patients
A 40-year-old male patient came to the outpatient clinic today, and I am very impressed with him Profound, because he is a significantly overweight patient. When I came to the outpatient clinic, the patient told me that his blood pressure was found to be elevated on a physical examination two years ago, and the highest blood pressure was 180/115mmHg. Check creatinine 102.5umol/L, triglyceride 4.05 mmol/L, low-density lipoprotein cholesterol 2.11 mmol/L, echocardiography showed ventricular septal thickening, left heart enlargement (left ventricular end-diastolic diameter 57 mm, ejection fraction 71% ). Fundus examination revealed fundus arteriosclerosis. Diagnosis: Hypertension. The patient is currently taking irbesartan and felodipine extended-release tablets (II) twice a day. The blood pressure is usually controlled at 150/95mmHg, and the heart rate is 63 beats/min.
I consulted in detail whether the patient had other diseases and whether there was a family history of the disease. The patient said that he had no other diseases, did not smoke at ordinary times, and drank occasionally, and his diet was a bit heavy and salty. Sometimes insomnia, no snoring. Usually walks a lot, has a cheerful personality, and the work pressure is a bit high. But the parents have a history of hypertension.
(Patient Lab Report)
II. Diagnosis and treatment process
The patient was male, 40 years old, BMI 33.6kg/m2, with a history of hypertension For 2 years, the highest blood pressure was 180/115mmHg, and there was no history of diabetes. The mother had hypertension, and had manifested target organ damage, including fundus arteriosclerosis, left heart enlargement, ventricular septal hypertrophy, and mild abnormal renal function.
According to the description of the patient and the diagnostic report he provided, I diagnosed him with grade 3 hypertension and hyperlipidemia. In response to the patient’s condition, I gave the following suggestions in detail: 1. According to the patient’s usual dietary taste, BMI 33.6kg/m2, it is recommended to actively control the weight and control the intake of salt. 2. The patient’s blood pressure is usually controlled at 150/95mmHg. According to the blood pressure, the target is generally below 140/90mmHg. If tolerated, it can be reduced to 130/80mmHg. However, the current blood pressure level, the patient has not reached the standard, so it is recommended that antihypertensive drugs can be adjusted. It is irbesartan and hydrochlorothiazide tablets once in the morning + felodipine sustained-release tablets once in the morning and evening, and regular aerobic exercise can be performed after the blood pressure reaches the standard. 3. Patients with high blood lipids are recommended to take atorvastatin calcium tablets orally, before going to bed for lipid-lowering, and regular follow-up for renal function, uric acid, and blood lipids.