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Strange HTN case

Nurses   (199 Views | 2 Replies)

1,696 Profile Views; 77 Posts

39 year old male

6 ft 200 lbs 

No significant hx 

BP in right arm 180/120. BP in left arm 144/98. HR 80. Radial pulses, pedal pulses  2+ Bilat. No bruits heard. Pt is basically asymptotic 

Been taking amlodipine 5mg daily x2 days, increased to 10 mg daily x4 days. 
 
BP is still unchanged

Labs done. No issues. Total cholesterol 261. Pt states he is sedentary  

Renal artery US ordered and scheduled

Chest CTA w/wo, and abdominal aorta CTA w/wo ordered and scheduled 

All imaging to be done over the next two weeks then f/u physical in PCP office. 
 

Thoughts? 
 

I’m kinda worried about the Norvasc not “kicking in” yet? Maybe it needs an extra antihypertensive med in the meantime... I don’t like the idea of someone running around with a SBP in the 170’s,180’s and DBP 120’s,130’s 

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"nursy" has 40 years experience as a RN and specializes in ICU, ER, Home Health, Corrections, School Nurse.

199 Posts; 819 Profile Views

I check my pressure at home and it's 130/80.. At the dentist 30 minutes later it's 179/100.  I have white coat syndrome big time.  That can be one possibility for your patient.  Also, more and more the experts are emphasizing the correct way to take a BP is with a patient resting without talking or any stimulation for 5 minutes before the reading is done. Then recheck readings at the end of the visit, when the stress levels may have gone down.   Also, if I take my own pressure several times in a row, they go down every time, as I sit quietly. So you take one reading in one arm and it's high, then a few minutes later the reading in the other arm is lower, cause the patient has been sitting quietly.   Admittedly, that's just me.  And you quite possibility have been doing everything perfectly, I just wanted to throw in the possibilities.   Also I'm surprised there was no at home monitoring ordered.   Other than that, the results of those tests will hopefully shed some light.

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17 Posts; 125 Profile Views

There shouldn’t be such a discrepancy between BPs taken on each arm. 
 

The tests/imaging ordered seems aggressive for typical hypertension. Are there any specific reasons or findings prompting this work up? 
 

How soon are tests going to be done? 

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