Blood Pressure Case Histories
Mr C was 45. His wife was a nurse and had been concerned about the occasional high readings she had found. His GP too had been keeping under observation. Examining him he appeared to have a forceful heart beat.
His blood pressure was ‘borderline’ (150/90). A 24hr recording showed some highs and quite a few normal readings. His echocardiogram showed very thickened heart muscle, typical of long established high blood pressure (hypertension).
We started him on treatment to stop further growth of his heart muscle and the muscular walls of his small arteries.
TAKE HOME MESSAGE: Once the heart muscle becomes thick (hypertrophied) the patient is in trouble, as far as his future risk of stroke is concerned.
Not all drugs control this. Just taking his blood pressure completely underrated his risk. Blood pressure is an effect of artery changes, not a disease process or illness in itself.
Mrs Y was a very large lady (20 stones +). She was said to have high blood pressure. As a nurse she was worried by her inability to take blood pressure lowering pills of any sort.
Taking her blood pressure in her forearm (no machine was big enough for her upper arm) seemed normal off of all treatment. She had a normal ECG and her echocardiogram (heart echo) was normal.
She was, however, very short of breath on minimal exercise. Exercise made her go blue! We concluded that she had a normal blood pressure, thought to be abnormal because of using too small a cuff on her upper arm.
She was feeling unwell on blood pressure lowering tablets simply because her blood pressure did not need lowering!. She was breathless Because she had the equivalent of a lawn mower engine trying drive a Centurion tank!
TAKE HOME MESSAGE: Never judge a book by its cover!
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