Patient Cases 2. A Patient with Apparent Resistant Hypertension
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CASE REPORT
Patient Cases 2. A Patient with Apparent Resistant Hypertension Carlos Aguiar1
Received: 16 March 2015 / Accepted: 8 June 2015 Springer International Publishing Switzerland 2015
Abstract True treatment-resistant hypertension (TRH) is defined by specific criteria and a failure to response to initial therapy options does not necessarily mean that a patient has TRH. In this case, a 44-year-old male was discharged on a fixed combination of valsartan/hydrochlorothiazide (HCTZ) 160/125 mg/day after presenting to the emergency room with paraesthesia of the upper left limb and recording a blood pressure (BP) of 190/110 mmHg. The patient had a number of other cardiovascular (CV) risk factors, and was determined to be at high risk of developing type 2 diabetes mellitus and of CV death. Carvedilol and atorvastatin were added, but 24-h ambulatory BP monitoring (ABPM) showed persistent hypertension. After specialist assessment, the patient’s antihypertensive regimen was switched to a fixeddose combination of olmesartan/HCTZ in the morning and a fixed-dose combination of olmesartan/amlodipine in the evening. Repeat ABPM 6 weeks later showed better BP control then previous ABPM. Keywords Ambulatory blood pressure monitoring Fixed-dose combination therapy Apparent treatment resistant hypertension
1 Introduction
was 190/110 mmHg, which decreased to 140/90 mmHg with diazepam ? captopril. He was discharged on valsartan/HCTZ 160/12.5 mg once daily. The patient had a number of CV risk factors, including a 20-cigarette/day smoking habit, a 6-year history of HTN, high cholesterol, abdominal obesity and lack of regular physical activity. He also had mild obstructive sleep apnoea (apnoea-hypopnoea index 7.5/h). The patient’s father had HTN, was a smoker, and had died from intracerebral haemorrhage (ICH) at age 64 years, and his mother had HTN, dyslipidaemia and type 2 diabetes mellitus (T2DM). Approximately 1 month later the patient visited his family physician. Physical examination revealed the following: • • • • • • • •
BP: 150/100 mmHg, weight: 88 kg, height: 165 cm, BMI 32.3 kg/m2, waist circumference: 115 cm, resting pulse: 80 beats/min, normal heart auscultation; no carotid or abdominal murmurs, no signs of heart failure.
A 44-year-old Caucasian male patient presented to the emergency room in November 2013 complaining of paraesthesia of the upper left limb. At this time, seated BP
A resting ECG showed sinus rhythm, complete right bundle branch block (RBBB) with left anterior fascicular block (LAFB), QRS 126 ms, and probable left ventricular hypertrophy (LVH). One week later, laboratory rest results were as follows:
& Carlos Aguiar [email protected]
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1
Cardiology Department, Hospital de Santa Cruz, Carnaxide, Portugal
haemoglobin: 16.2 g/dL, haematocrit: 49.5 %, fasting plasma glucose: 89 mg/dL,
C. Aguiar
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fasting lipids: total cholesterol; 243 mg/dl, HDLcholesterol, 50 mg/dL; LDL-cholesterol, 164 mg/dL; triglycerides, 145 mg/dL, electrolytes: sodium, 143 mEq/L; potassium, 3.9 mEq
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