A 46-year-old man reports intermittent headaches and light-headedness for about 3 months. In the past 2 weeks, he has had several episodes of epistaxis. Vital signs are temperature, 98.6°F; pulse, 106; respirations, 20; and blood pressure, 168/98. His weight is 265 lbs., and his height is 5 feet, 11 inches. The history reveals that the patient has a highly stressful job requiring extensive travel with overnight stays. He regards himself as a high achiever. A family history discloses that his father died at 53 years of age of a CVA and that his mother at 69 years of age has CHF and hypertension. His brother has a history of hypertension, and his two sisters are alive and well. The patient smokes one pack of cigarettes a day and has for 30 years. The patient is advised to stop smoking or at least cut down on the number of cigarettes smoked per day. In addition, he is advised to begin a weight-reduction and exercise program and to reduce sodium intake. If possible, he also should reduce stressful situations. Medications ordered are a beta-blocker, atenolol, and an ACE inhibitor, ramipril. The patient is instructed to return in 1 week for reevaluation. Essential hypertension is a suspected diagnosis.
What factors contribute to the symptoms and signs of essential hypertension that this patient is experiencing?
Why would his onset of symptoms be considered insidious?
. Why could the diagnosis of essential hypertension not be confirmed on the initial encounter?
. Why might a diuretic be ordered?
. What is the significance of the family history?
What is the action of CCBs in the treatment of essential hypertension?
If essential hypertension is not controlled, what complications may evolve from the condition?
How important was the symptom of epistaxis in the diagnosis?
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