Hypertension
Sociodemographic details
• Name: S.Subbulakshmi
• Age. :68
• Sex. :female
• Education: 10th
• Address:kovur
• Occupation :House wife
• Religion:Hindu
Chief complaints
•Leg pain 3 days on rt leg
•Sweating for 2 days
•Giddiness for 2 days
Presenting complaints
• The patient was apparently normal 3 days
back when she Started complaints of leg
pain on the right side calf muscles which
was insidious in onset .Pain was progressive
for 3 days aggravated on walking and
relieved by rest which was acute and dull
aching in nature non radiating .
•Then she complaints of giddiness
which is sudden in onset
progressive for 2 days
aggravated by standing from bed
and relieved by rest.
•Then she also presented with
sweating in the morning which is
profuse in nature. Aggravated on
exertion and relieved by rest.
•No h/o of general fatigue
•No h/o of altered
consciousness,
headache,vomiting and
blurring of vision , difficulty
in breathing.
Past history
• She was a known case of hypertension for the
past 5 yrs. She treated with TELMISARTAN 40mg
OD for past 5 yrs. But poor compliance because
she is forgetful to take medicine on time.
• She prescribed with ATORVASTATIN at night for
high cholesterol
• Presence of similar episodes in the past with BP
160/90mmhg . She is going for the regular
checkup every 6 months once.
.h/o of previous hospitalization for cataract
• No h/o of diabetes mellitus
• No h/o of coronary artery disease
• No h/o premature or surgical
menopause
• No h/o of CNS disorder-like hemiplegia
and stroke
• No h/o of previous heart attack
• No h/o of bronchial asthma
• No h/o of drug allergy
• No h/o of ocp use
•
Personal history
•Mixed diet
•Normal bowel and bladder
•Reduced sleep
•H/o of betel nut chewing now she
withdrawn from it for past 3 yrs
•No h/o of smoking and alcohol
Family history
•No h/o of similar complaints from
family members
•Her husband is a known case of
DM for the past 10 yrs.
•Type of family : Nuclear family
•Total no. Of family members:2
Family composition
Name of Age/sex Relationsh Education Occupatio Income Health
the family ip to the n status
members head of
the family
Selvam 75/male Head of the 9 Gardening 8000 DM for 10
family work yrs
Subbulaksh 68/female Wife 10 House wife - HTN for 5
mi yrs
•Per capita income/month=
Total income of the family/
Total no. Of family members
8000/2 =4000
According to the modified
BG PRASAD SCALE the
Family belongs to middle
Class.
Diet history
Food intake Calorie consumed Protein consumed
(kcal) (g)
Morning 2 idles 25×2=50 0.8×2=1.6
1 cup of coconut 55 1.7
chutney
Afternoon 1 cup of rice 260×1=260 4.8×1=4.8
1 cup of sambhar 123 6.1
vegetables 29×3=87 0.8×3=2.4
Evening Tea with milk 100ml 64 2.5
Dinner 2 chapatti 158×2=316 4.8×2=9.6
1 cup of kuruma 91 2
RDA for Energy/protein Energy/protein
sedentary (kcal)/(g) deficit
Worker
Calorie(kcal)=16 1046 614 kcal
60
Protein(g)=36.6 30.7 5.9 g
Environment history
•Pucca house,independent, no set
back is present
•1 bedroom with attached
bathroom has 1 window and 1
door
•1 living area with 2 windows and
1 door with separate kitchen
•No overcrowding present
•Separate kitchen ,LPG
gas,exhaust present, kitchen
slab present , groceries are
stored in closed vessels, sullage
disposed into open drain
•Source of drinking water: RO
SYSTEM
•Separate toilet present , Indian style,
sanitary
•Sewage disposed into septic tank
•cross ventilation and Lighting are
adequate
•Garbage disposal collected by
municipality daily
•No cracks in the walls & floor
•Mosquitoes breeding is present
General examination
• patient was moderately built , well
nourished ,comfortable
•Conscious and oriented to time , place and
person
•Pitting pedal edema on both the legs.
•Pallor ,
icterus ,cyanosis ,clubbing ,lymphadenopath
y not present
Vitals
• HR: 81 BPM
• RR:19 BREATHE/MINUTE
• TEMP:98.8 DEGREE FAHRENHEIT
• SPO2:98%
• BP: 150/90mmhg manually by
sphygmomanometer (sitting position)
Anthropometry
•Height:155 cm
•Weight:65 kg
•BMI: weight in kg / height
in m2
65/ 2.4= 27
She Belongs overweight
CVS EXAMINATION:
Inspection: apical impulse is seen , no
visible pulsation seen , no scar of
sinuses . Trachea in central in position.
• Palpation: all the Inspectory findings
are confirmed. Apical impulse confirmed
at 5th intercostal space at midclavicular
border. Cardiac borders are normal.
Auscultation
•Bilateral normal vesicular
breath sounds no murmurs.
•Percussion: resonance felt
on the lungs and cardiac
borders are dull
Systemic examination
•RS :vesicular breath sounds , no
added sounds heard
•Abdomen: soft, no organomegaly
, scar and flank is free
•CNS: no focal neurological deficit
Provisional diagnosis
The patient is diagnosed as
primary hypertension.
Community diagnosis
•Mrs subbulakshmi , 68 yrs old
female housewife from kovur came
to an opd with the chief complaints
of leg pain for 3 days and giddiness
and sweating for 2 days. she is from
nuclear family and living with her
husband who is a diabetes pt for
past 10 yrs.
She belongs to middle class
family according to modified BG
PRASAD SCALE.Residing in the
pucca house adequate lighting
and ventilation with separate
kitchen. Overcrowding is not
present.
She was a known case of HTN
for past 5 yrs. Betel nut
chewing wss present and
withdrawn from it past 3 yrs
with no smoking and alcohol
she is not aware about taking
the BP tablets regularly.
Investigation
• Lipid profile-total CHL, HDL,LDL ,
TRIGLYCERIDES
• Blood fasting glucose and hemogram
• Renal parameters- blood urea nitrogen,
serum creatinine, TFT , serum na+ and k+
• Urine examination and urine
microalbuminuria
• ECG ECHO
• Fundal examination
Treatment
•Diet Modification-DASH diet
•physical exercise
•Antihypertensive drugs like
ABCD
•Lipid lowering agent and
cardio protective drugs.
Advice to the patient
• Don’t skip the food and medications
• Avoid of tobacco
• Do moderate exercise for 30 minutes
• Positive social contact and medication.
• Regular BP checkup and follow up.
• Management of comorbidities like
reduce TG and CHL.
Advice to the family
•Everyone must aware abt the
causes of HTN
•Consume low sodium content
food avoid preservated foods
and pickles.
•Screening of high risk for HTN.
Advice to the commnunity
•Look for the similar case in the
communtiy and treat them
•Create awareness abt HTN.
•Screening of high risk individuals
for HTN in the community.
Programmes: NPCDCS
•Modifiable factors:1.obesity
2.salt intake 3.saturated fat
4.dietary fibre 5. Alcohol 6.
Heart rate 7.physical activity
8. Environmental stress 9.
Socioeconomic status 10.
Other factors like estrogen
Non modifiable factors:
1.Age
2.Sex
3.Genetic factors
4.Ethnicity
Rules of halves
• 1.the whole communtiy
• 2 . Normotensive subjects
• 3. Hypertensive subjects
• 4.undiagosed hypertension
• 5. diagnosed hypertension
• 6. Diagnosed but untreated
• 7.diagnosed and treated
• 8.inadequately treated
• 9.adequately treated
•Bp can be recorded by manually and
also digitally.
•Tracking of BP means individuals were
followed up over a period of yrs from
early childhood into adult life. It is
helpful to find the risks at future
•Bp should be measured at least 3 times
over a period of atleast 3 minutes and
the lowest reading recorded.
Test done for HTN patient:
• Once In 3months- renal test, blood sugar
• Once in yr- x ray
chest/ECG/ECHO/DOPPLER(peripheral
vascular assessment)
• Complication: hemiplegia , hypertensive
encephalopathy, renal failure ,heart
failure, renal hemorrhage ,
cardiomyopathy
Levels of prevention
•Sheis not cured by primary
prevention
•Currently she is under the
secondary prevention.
Thank
you
