Dr. Ally, a 49-year-old professor, was diagnosed with essential hypertension 12

Question

Dr. Ally, a 49-year-old professor, was diagnosed with essential hypertension 12 years ago and was on antihypertensive drugs. However, he did not take his medications last year because he was feeling just fine. In addition, he was very busy with work. Nevertheless, he felt tired after work and developed dyspnea while climbing the stairs. Recently, he had a bout of epistaxis (severe nose bleed) with dizziness and blurred vision. He went to the doctor for a checkup. His blood pressure was 180/110, and the doctor found rales or crackles on his chest upon auscultation. The doctor ordered rest and asked him to start his medication again.

What are the patient's problems?

What pathophysiological changes are happening in his eyes and heart?

According to the doctor, the patient might have developed congestive heart failure. Is it right-sided or left-sided?

What medications are likely to have been used? Describe the mechanisms of actions of at least two antihypertensive drugs.

Explanation / Answer

High blood pressure is essential that is primary or secondary. Primary is due to nonspecific lifestyle and genetic factors. Lifestyle factor that cause hypertension are uset of excess salt, more body weight, smoking and drinking alcohol. So, this must have caused the hypertension in the said person.

The patients problems include headaches,visual changes, fatigue or dizziness. But these can occur with other conditions as well.  

When blood pressure is too high, the blood vessels of retina walls may thicken. So they will become narrow. As a result blood cannot reach retina. Sometimes retina can become swollen. This condition is called as hypertensive retinopathy.

Similarly, in heart also blood supply to the heart itself will be hampered. This can lead to heart failure or ischemic heart disease. And eventually to left ventricular hypertrophy (excessive thickening of he heart muscle )

In addition to lifestyle changes,medications include calcium channel blockers and angiotensin converting enzyme inhibitors. By counter regulatory mechanisms these will reduce the blood pressure.

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