Case Example 1:
I have seen a patient recently who was referred to me as a "young hypertensive". On further questioning it transpires that she had taken a few recreational substances at a party, became unwell; then went to the Accident and Emergency Department.
As one expected her blood pressure was elevated due to the ecstasy tablet. She was subsequently discharged and advised to have her blood pressure monitored. Unfortunately she became anxious about her blood pressure, and all subsequent blood pressure readings were elevated. After I evaluated her, all tests revealed that she was not hypertensive, but had developed "white coat hypertension", and subsequently reassured and the pressure went back to normal.
Case Example 2:
A 58 year old business man was having a routine health check. Quietly, he admitted to having problems with his sex life. At first, he claimed that he had lost his sex drive. On further questioning he volunteered that although he was tired and overworked, his ability to sustain an erection was also diminished. Investigations subsequently revealed that he was overweight, mildly hypertensive and had a raised cholesterol profile. His alcohol consumption was above average. He had no features of target organ damage.
Before any treatment was offered, lifestyle advice was given. Over the next three months he dramatically reduced his alcohol consumption and reduced weight considerably. His blood pressure returned to normal as did his cholesterol profile. He continues to be monitored for blood pressure and cholesterol levels.
Case Example 3:
In a routine medical a 53 year old lady was found to have a raised blood pressure (160/90). A series of blood pressure checks revealed a somewhat labile pattern of varying blood pressures. She was generally unkeen on having any medication. Clinical evaluation revealed that she had thickened retinal eye blood vessels and thickened heart muscle, both features of target organ damage. As she had these features, she was managed with a combination of lifestyle and low dose medication. Her cholesterol profile was borderline, but in view of the substantiated diagnosis of hypertension, she also agreed to have her cholesterol treated with medication.
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