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Abstract: The patient in this case is a 56-year-old female, who presented to the hospital with sudden onset of vertigo and nausea, which are the most frequent symptoms of hypertension and are more frequent in female patients, and most of them were effectively relieved when the blood pressure was controlled smoothly. After admission, the patient was treated with medication and daily regimen, and her blood pressure was well controlled, her dizziness was relieved, and she did not have any more symptoms such as vertigo and nausea.
Basic information】Female, 56 years old
Disease Type】Chronic hypertension
Hospital】The First Affiliated Hospital of Anhui Medical University
Date of Consultation】January 2022
Treatment plan】Medication (nifedipine controlled-release tablets, perindopril tert-butylamine tablets)
Treatment period】7 days of inpatient treatment, 2 months of outpatient follow-up
Treatment effect] The symptoms of vertigo and nausea improved, and the blood pressure was stable.
I. Initial consultation
The patient, who was accompanied by her husband, had a fat body type and reported sudden onset of dizziness 1 week ago, which started when she woke up and was relieved by resting for a few minutes. In recent days, she has been experiencing recurrent dizziness with nausea and difficulty in standing when the dizziness is severe. On examination: blood pressure was 162/82 mmHg, mental clarity, poor spirit, slightly large heart borders, rhythmical, no pathological murmur heard in each valve auscultation area, physiological reflexes existed, pathological signs were not elicited, combined with the medical history and physical examination, the patient was initially diagnosed as chronic hypertension.
II. Treatment
After admission, we communicated with the patient and his family that vertigo and nausea should first be ruled out as a stroke, and that cerebral hemorrhage could be ruled out because he had already undergone cranial CT examination in an outside hospital. Further improvement of ambulatory blood pressure monitoring: mean blood pressure 146/76 mmHg (normal <130/80 mmHg), daytime 154/80 mmHg (normal <135/85 mmHg), nighttime 132/64 mmHg (normal <120/70 mmHg). The cardiac ultrasound suggested septal thickening and high blood lipids. Since he already had a combination of hypertensive heart disease, the patient was advised to take a combination of nifedipine controlled-release tablets + perindopril tert-butylamine tablets to control blood pressure and keep it below 130/80 mmHg as much as possible.
(Cardiac ultrasound)
III. Treatment effect
The patient was treated with oral nifedipine controlled-release tablets on the day of admission, and the blood pressure was controlled at 148/76 mmHg, and the dizziness was relieved. After further improvement of cardiac ultrasound and ambulatory blood pressure on the second day after admission, Perindopril tert-butylamine tablets were added on the second day to lower the blood pressure and reverse the ventricular remodeling, and after 7 days of hospitalization, the blood pressure was controlled at about 132/78 mmHg, and the dizziness was obviously relieved without any nausea attack. After the discharge, he was followed up in the outpatient clinic for 2 months, and his blood pressure was controlled below 130/80 mmHg, and he did not have any more symptoms such as dizziness and nausea.
IV. Notes
We are glad that after treatment the patient’s vertigo improved and blood pressure was smoothly controlled. Because of the patient’s fat body size and less exercise in general, he was advised to strengthen lifestyle interventions.
1.In the diet, pay attention to reduce the intake of saturated fat and cholesterol, eat more fresh fruits and vegetables, and review the blood lipids regularly to restore them to normal values as quickly as possible.
2, adhere to exercise, such as jogging, swimming, jumping gymnastics, etc., of course, the exercise should be appropriate, avoid long and strenuous exercise.
3, weight control, obesity will lead to excessive burden on the heart, causing an increase in blood pressure, so it is necessary to control the body mass index BMI below 24kg/m2.
4.Pertindopril tert-butylamine tablets were applied to the patient’s cardiac hypertrophy.
V. Personal insight
The incidence of chronic hypertension has been increasing, but it is mostly insidious, and complications often appear when it is discovered. The obese people are more likely to suffer from hypertension, and the obese body burden is too heavy to induce left heart hypertrophy and blood pressure rise, for obese patients, early blood pressure monitoring is especially important. In this case, the ultrasound of the heart at the time of admission indicated septal thickening and target organ damage of hypertension. Therefore, obese patients should have early weight control, strengthen blood pressure monitoring, and early intervention and treatment.