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Abstract: Recurrent dizziness and palpitations with generalized weakness and insomnia may be an early manifestation of hypertension. Early treatment of this disease through lifestyle interventions, medications, and other comprehensive treatments will improve symptoms such as dizziness and palpitations in most patients. In this case, the patient came to the hospital with recurrent dizziness and palpitations, generalized weakness, and insomnia, and was diagnosed with simple diastolic hypertension, which improved with medication.
Basic information】Male, 42 years old
Disease Type】Simple diastolic hypertension
Hospital】The First Affiliated Hospital of Anhui Medical University
Date of consultation】January 2022
Treatment plan】Medication (felodipine extended-release tablets + metoprolol succinate extended-release tablets + zopiclone tablets + ramipril tablets)
Treatment period】5 days of hospitalization and 3 months of outpatient follow-up
Treatment effect] Dizziness and palpitations relieved, sleep improved
I. Initial consultation
The patient reported recurrent dizziness and palpitations in the past 1 week, accompanied by general weakness and insomnia, the initial degree was mild, but the dizziness and palpitations increased significantly in the past 2 days, and it was difficult to sleep at night and concentrate at work during the day. On examination: BP 138/102 mmhg, P106 beats/min, clear consciousness, poor mental health, clear breath sounds in both lungs, and no dry and wet rales. The heart border was not large, the heart rate was 106 beats/min, the rhythm was uniform, and no pathological murmur was heard in the auscultation area of each valve. Physiological reflexes were present, and pathological signs were not elicited. The patient was judged to have simple diastolic hypertension.
II. Treatment history
We explained to the patient and his family that the patient’s dizziness and palpitations were caused by high blood pressure and rapid heart rate, so the treatment was based on controlling blood pressure and heart rate (felodipine extended-release tablets + metoprolol succinate extended-release tablets), and supplemented with drugs to improve sleep (zopiclone tablets). On day 2, further renal function, urine protein test, ambulatory electrocardiogram, ambulatory blood pressure and cardiac ultrasound were performed according to the condition. After the inpatient course, the patient continued to take oral medication and followed up regularly at the outpatient clinic, and the ECG and cardiac ultrasound were reviewed at the hospital after 3 months.
Treatment effect
On the day of admission, the patient started the antihypertensive regimen (felodipine extended-release tablets + metoprolol succinate extended-release tablets), and the dizziness and palpitations were relieved after 6 hours, at which time the blood pressure was monitored at 130/94 mmhg and the heart rate decreased to 88 beats/min. On the second day, the electrocardiogram showed sinus rhythm, and the complete cardiac ultrasound showed septal thickening. The combination of antihypertensive drugs (ramipril tablets + metoprolol succinate extended-release tablets) was changed, and the blood pressure decreased to 130/82 mmhg after 4 days. After discharge, the patient was followed up in the outpatient clinic for 3 months, with no symptoms such as dizziness and palpitations, and the blood pressure was controlled at about 120/70 mmhg.
IV. Precautions
We are glad that the patient’s condition has improved after medication, but we suggest that the patient still needs to pay attention to weight control after discharge from the hospital. Maintain a healthy work style and lifestyle, arrange work and rest time reasonably, avoid excessive fatigue, and ensure sufficient sleep; pay attention to adjusting tension, transferring work pressure, and maintaining a calm state of mind. If your blood pressure is not stable, you should consult a doctor as soon as possible.
V. Personal insight
Hypertension is defined as a systolic blood pressure ≥ 140 mmhg and/or diastolic blood pressure ≥ 90 mmhg without the use of antihypertensive drugs, while the diagnostic criteria for simple diastolic hypertension are systolic blood pressure < 140 mmHg and diastolic blood pressure ≥ 90 mmHg. As in this case, diastolic hypertension is usually due to work, stressful life, sympathetic hyperexcitability and overactivation of the RAAS system, resulting in increased heart rate, increased peripheral vascular resistance and thus increased diastolic blood pressure. Generally, as in this patient, pharmacological intervention can effectively relieve the symptoms and avoid cardiovascular complications. Therefore, high diastolic blood pressure should be treated as soon as possible.