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Abstract: The first thing that comes to mind when sudden numbness of the hands and feet occurs is stroke and peripheral neuropathy, but in fact, one should also be alert to the presence of hypertension. In this case, the patient presented with numbness in the hands and feet due to long-term ineffective control of primary hypertension. Under the doctor’s guidance, through the adjustment of antihypertensive drugs and lifestyle intervention, the blood pressure was stabilized and the numbness in the hands and feet was significantly relieved until it disappeared.
Basic information】Male, 66 years old
Disease Type】Orthostatic hypertension
Hospital】The First Affiliated Hospital of Anhui Medical University
Date of consultation】January 2022
Treatment plan】Medication (amlodipine benzoate tablets, benazepril hydrochloride tablets, irbesartan hydrochlorothiazide tablets) + lifestyle intervention (salt restriction, alcohol restriction, smoking cessation, moderate aerobic exercise)
Treatment period】7 days of hospitalization, outpatient review after 3 months
Effectiveness of treatment】Numbness in hands and feet significantly relieved to disappeared
I. Initial consultation
The patient was a 66-year-old man, accompanied by his son and daughter to our hospital. The patient reported sudden onset of numbness in his hands and feet in the morning of the same day, but his activities were still fine. Since he usually had hypertension, but took medication irregularly, and had a long history of smoking and drinking, his children were worried that he had a sudden stroke, so they came to our hospital urgently. On examination, he was found to have a BP of 178/80 mmHg, a clear consciousness, an average spirit, an enlarged heart border to the left, and a rhythm. The diagnosis of primary hypertension was made.
II. Treatment history
The patient was admitted to the hospital, and the blood pressure still reached 180/80 mmHg on re-test after admission. The patient was first given amlodipine besylate tablets + benazepril hydrochloride tablets to lower the blood pressure, and blood pressure monitoring was also strengthened. Since the onset of numbness in the patient’s hands and feet was relatively short, the possibility of acute cerebral infarction could not be ruled out. The patient was already suffering from hypertension, but taking medication irregularly for a long time. After communicating with the patient’s family, relevant examinations were carried out for early detection of hypertensive complications, and the examination of cardiac ultrasound indicated septal thickening and left ventricular hypertrophy, carotid ultrasound showed carotid artery plaque formation (Figure 1), and electrocardiogram indicated left ventricular high voltage. Hydrochlorothiazide tablets.
Treatment effect
On the day of admission, the patient was given the combination of amlodipine besylate tablets + benazepril hydrochloride tablets to lower the blood pressure to 156/70 mmHg, and the numbness in the hands and feet was slightly relieved. After excluding acute stroke and completing cardiac ultrasound and cervical vascular ultrasound, the treatment plan was adjusted to amlodipine besylate tablets + irbesartan hydrochlorothiazide tablets. After 7 days of systemic treatment, the patient’s blood pressure dropped to 140/66 mmHg at discharge in a tolerable condition, and the numbness of the hands and feet disappeared. Three months after discharge, the cervical vascular ultrasound was repeated in the outpatient clinic indicating no plaque progression.
IV. Precautions
The patient’s blood pressure stabilized, and as the attending physician, we are sincerely pleased. The patient is an elderly male with a history of hypertension for many years, but he usually takes medication irregularly, so after discharge, he should first ensure regular and long-term oral medication. The patient has hypertension, but still maintains certain bad habits, such as smoking and drinking alcohol, and these patients have a poor long-term prognosis, so they need to quit smoking and drinking. The patient has a large pulse pressure difference, so care should be taken to avoid low diastolic blood pressure every time the blood pressure is measured. After applying the diuretic Irbesartan Hydrochlorothiazide Tablets, the combined antihypertensive effect is quite good, but attention should be paid to the electrolyte disorder and elevated blood uric acid.
V. Personal insight
With the popularization of various medical knowledge, people have a certain understanding of stroke, which is also commonly known as stroke. When there is numbness in the limbs, the first thing to consider is stroke and ignore the harm caused by hypertension itself. In this case, the numbness of the hands and feet was caused by the spasm of small veins throughout the body because of the lack of attention to the control of blood pressure by medication. Therefore, keeping blood pressure stable and insisting on long-term medication is the key to avoid such symptoms. Once the symptoms of discomfort appear, it is important to seek timely medical attention and treat the symptoms.