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Abstract: The patient in this case is a 46-year-old male who was found to have elevated blood pressure on physical examination 2 months ago, and stopped taking medication to control his blood pressure on his own. Combining the family history and relevant physical examination, the patient was confirmed to have diastolic hypertension and was admitted to the hospital for treatment. After admission, the patient was treated with oral medication, and his blood pressure was effectively controlled and his symptoms improved significantly.
Basic information】Male, 46 years old
Disease Type】Diastolic hypertension
Hospital】Wuhan University People’s Hospital
Date of Consultation】February 2021
Treatment plan】Medication (sakubatril valsartan sodium tablets, metoprolol succinate extended-release tablets)
Treatment period】5 days of inpatient treatment, outpatient follow up
Treatment effect] Blood pressure was effectively controlled, symptoms improved significantly, and she was discharged successfully
I. Initial consultation
The patient is a 46-year-old male with an obese body type who came to the hospital because of poor blood pressure control for more than half a month. The patient was given nifedipine extended-release tablets for antihypertensive treatment, and stopped the drug on his own after one month. Half a month ago, he occasionally felt dizzy and panicky, and his blood pressure was measured high at home, and he did not continue to take antihypertensive drugs, so he came to the clinic. Careful questioning of the patient, the patient described that due to high mental stress, which may be a trigger for hypertension, but the symptoms were aggravated by not having good control of diet and weight and not exercising to lose weight; and both parents had hypertension, and the uncle also had hypertension. On physical examination, the patient had a blood pressure of 148/120 mmHg and a heart rate of 79 beats per minute. In summary, considering that the patient was found to have high blood pressure for the first time and had a family history of hypertension, he was initially considered to have diastolic hypertension, but tests were still needed to confirm the diagnosis and to exclude hypertension caused by other diseases, so the patient was admitted to the hospital to further clarify the diagnosis.
II. Treatment history
After admission, the patient underwent blood tests and was found to have high blood lipids, mainly triglycerides, which were 3.86 mmol/L. 24-hour ambulatory blood pressure monitoring revealed that the diastolic blood pressure was always higher than 100 mmHg; electrocardiogram showed high voltage in the left ventricle, and cardiac ultrasound did not show any significant abnormalities. Therefore, secondary hypertension due to renal, endocrine, and thyroid diseases such as adrenal adenoma and primary aldosteronism can be preliminarily excluded. The patient was given a combination of two antihypertensive drugs, sakubatril valsartan sodium tablets and metoprolol succinate extended-release tablets, to keep the blood pressure within the normal range.
III. Treatment effect
The patient was hospitalized for 5 days and underwent continuous blood pressure testing. The blood pressure was basically controlled within 140/90 mmHg, and the blood pressure level was relatively stable, and no other uncomfortable symptoms occurred during the drug administration. At the one-month outpatient follow-up, the patient felt well and did not have any uncomfortable symptoms, and also paid attention to lifestyle changes, and successfully lost 6 pounds, and the systolic blood pressure was controlled at 115-128 mmHg, diastolic blood pressure at 68-78 mmHg, and triglycerides at 1.02 mmol/L. The patient indicated that he was satisfied with this treatment effect and would continue to lose weight.
IV. Precautions
The patient in this case, through early detection and active treatment with doctors and lifestyle adjustment, gradually recovered from the disease, and we are truly happy for him. However, for patients with diastolic hypertension, medication is only part of the treatment, but care needs to be taken to avoid stopping medication on your own or not taking it regularly. Lifestyle changes also need to be taken seriously. You should actively control your weight, take appropriate sports, such as swimming and jogging; do not smoke and do not drink alcohol in excess; pay attention to reducing mental stress and maintaining psychological balance. Avoid a diet high in oil, salt and sugar, and focus on a light and nutritious diet so as not to affect the stability of blood pressure level control.
V. Personal insight
The patient in this article is a middle-aged diastolic hypertensive patient with a relatively obese body type.
For middle-aged patients with diastolic hypertension, when blood pressure is not well controlled or when other new symptoms or organ damage appear, please seek medical attention to adjust antihypertensive medication. Doctors should do a good job of health education, informing patients of the benefits of taking antihypertensive medications regularly and the consequences of not taking them regularly to get their attention to better reduce the risk of cardiovascular death and disability.