A 52-Year-Old Man With Blurred Vision and Headache

Basma Abdulhadi, MD


February 05, 2018

In this case, the patient's blood pressure was decreased by 20% in the medical intensive care unit over a couple of hours. He slowly became more awake and returned to his baseline mental status over the next 24 hours. He was transitioned back to his oral antihypertensive regimen. Upon further questioning, he reported running out of his blood pressure medications 1 week before his presentation. He was counseled on the importance of taking his blood pressure medications daily and the importance of keeping his blood pressure within normal ranges to avoid progression to cardiovascular and cerebrovascular disease.

The presence of left ventricular hypertrophy on ECG for a hypertensive patient is indicative of poor blood pressure control. Left ventricular hypertrophy can occur when the ventricle has to pump against a high afterload from elevated blood pressure. The presence of left ventricular hypertrophy has previously been shown to be associated with worsening outcomes, including sudden cardiac death, cardiovascular events, heart failure, acute stroke/transient ischemic attack, and increased all-cause and cardiac mortality.[5,8,9] Given its prognostic value, the presence of left ventricular hypertrophy should prompt improved blood pressure control to prevent further complications of uncontrolled hypertension.[8,9,10]

Addressing the patient's other comorbidities are also important to reduce his overall risk for cardiovascular disease. He now has diabetes and hyperlipidemia. He is on atorvastatin to control his hyperlipidemia. His diabetes should be optimized and monitored regularly, with a goal A1c level of 6%-7%. He was counseled about the importance of exercise and diet. Ensuring outpatient follow-up and risk factor modification is also crucial to prevent further hospitalizations and cardiac complications.


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