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Abstract: A 67-year-old female with dizziness for more than half a month and a past history of diabetes mellitus and hypertension, recently with poor glycemic control and unstable overall blood pressure control, feeling high and low. During the treatment, the relevant examination was further improved, and the dizziness was basically determined to be caused by hypertension. After adjusting oral antihypertensive drugs and controlling hyperglycemia with hypoglycemic drugs, the patient’s condition stabilized and the dizziness disappeared.
Basic information】Female, 67 years old
Disease Type】Hypertension
Hospital】Harbin First Hospital
Date of consultation】June 2022
Treatment plan】Oral medication (Shakubatra valsartan sodium tablets, metoprolol tartrate extended-release tablets, engelecgonine tablets)
Treatment period】7 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】The disease has been controlled, all indicators are improving, and the dizziness basically disappeared after optimizing the treatment and medication regimen
I. Initial consultation
Today, I was on duty in the ward when an elderly woman with dizziness for more than half a month and three days of aggravation came to the ward accompanied by her family with an inpatient order for treatment. Through detailed communication, I learned that the patient had been diagnosed with hypertension and diabetes mellitus, and usually took oral nifedipine controlled-release tablets to lower blood pressure, oral metformin glipizide tablets and subcutaneous insulin injection to control blood sugar. In the past half month, the patient felt dizzy. In the last 3 days, the dizziness worsened and he came to hospital for treatment and adjustment. The patient basically did not exercise in his daily life, and his diet was not strictly controlled.
The examination revealed that: blood pressure: 170/92 mmHg; heart rate: 90 beats/min; fasting blood sugar: 9.5 mmol/L.
II. Treatment history
The patient’s poor blood pressure control not only requires adjustment of the antihypertensive drug regimen, but also unstable blood glucose, failure to improve in combination with lifestyle interventions, and irregular medication taking can lead to unstable blood pressure. During the treatment process, we first adjusted the antihypertensive drug regimen and recommended that the patient take oral sakubatril valsartan sodium tablets and metoprolol tartrate extended-release tablets in combination with nifedipine controlled-release tablets to lower blood pressure. The patient’s blood pressure and pulse rate are monitored daily, and ambulatory blood pressure monitoring (below) is performed to help understand the overall fluctuations in blood pressure. In order to better control blood pressure, it is important to control blood glucose, monitor blood glucose and glycated hemoglobin seven times a day, and consult with the endocrinology department to adjust the use of hypoglycemic drugs, adjust the dosage of insulin injection, and add enkephalin tablets.
III. Treatment effect
After systematically adjusting the antihypertensive and hypoglycemic drug regimen and actively combining with lifestyle interventions, the patient’s blood pressure was basically stable at about 130/70 mmHg, heart rate was reduced to a stable level of about 60 beats/min, fasting blood glucose was stable, and postprandial blood glucose was about 6.5 mmol/L. The overall abnormal indexes were all normalized, or even in a very desirable state. After 7 days of inpatient treatment, the patient’s dizziness basically disappeared, and the patient was discharged from the hospital and instructed to have a one-month outpatient follow-up.
IV. Precautions
The patient’s blood pressure and blood glucose were controlled, and we were sincerely happy for the patient. After discharge, we advised the patient to pay attention to good blood glucose control, and to pay attention to intensive lipid-lowering therapy to prevent myocardial infarction and cerebral infarction, and to control LDL below 1.8 mmol/L as much as possible. Strictly low-salt, low-fat and low-sugar diet, pay attention to regular monitoring of indicators, and go to the hospital for a physical examination review every six months to one year to clarify whether there is any target organ damage. When blood pressure is unstable or there are symptoms of cardiac discomfort, it is recommended to seek medical attention promptly.
V. Personal insight
For patients with unstable hypertension, do not just focus on adjusting the antihypertensive drugs themselves, the choice of antihypertensive drugs is crucial, but do not ignore the details related to hypertension treatment. In order to better control blood pressure, in addition to taking regular oral antihypertensive medication that suits your actual situation, you must combine it with lifestyle interventions to improve and control the factors that can affect your blood pressure, which will help keep it within the ideal range.
In addition, especially for patients with hypertension combined with diabetes, it is necessary to control the LDL in blood lipids to the ideal state, which will help delay the progress or emergence of atherosclerosis, because hypertension, high blood lipids and high blood sugar are independent high-risk factors for cardiovascular disease, so it is necessary to strengthen lipid-lowering treatment.