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doc4mindia
Forum Guru Topics: 134 Posts: 243 |
A 68-year-old man has a blood pressure of 172/110 mm Hg while sitting and 178/112 mm Hg while standing, with a pulse rate of 66/minute. Two days later his blood pressure is 192/118 mm Hg. He has a 40-year history of well-controlled mild hypertension and he takes propranolol 40 mg two times/day. He has a history of angina pectoris and has smoked one pack of cigarettes/day for 50 years. Laboratory studies show no abnormalities. The most likely cause of his worsening hypertension is: a. Pheochromocytoma b. Progressive sodium retention secondary to dietary indiscretion and propranolol use C. Renal artery stenosis d. Tachyphylaxis to propranolol
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almozaffar
| Forum Newbie Topics: 0 Posts: 4
this presentation is telling us that the HTN started in a very young age of this patient, so we have to R/O renal artery stenosis.
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dimps
| Forum Guru Topics: 63 Posts: 446
hi doc4mindia can u tell us the answer
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doc4mindia
| Forum Guru Topics: 134 Posts: 243
almozaffar is correct
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mingle
| Forum Senior Topics: 27 Posts: 108
why not phaeo? 2 days later the bp increassed by 20 systolic, phaeos are known to have episodic elevations of the bp
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mingle
| Forum Senior Topics: 27 Posts: 108
why not phaeo? 2 days later the bp increassed by 20 systolic, phaeos are known to have episodic elevations of the bp. if it was renal artery stenosis the q would be using ace is instead of propranolol
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doc4mindia
| Forum Guru Topics: 134 Posts: 243
The answer is C In patients with renal artery disease, hypertension can result from increased renin secretion and decreased renal perfusion. Although renal artery disease is most frequently caused by atherosclerosis, ii can be caused by fibromuscular hyperplasia in younger patients. Typical presentations include worsening of preexisting hypertension or new onset of hypertension in older individuals. Bruits may or may not be heard on physical examination; however, their absence does not rule out the disease. Although bilateral renal artery disease may produce renal insufficiency, unilateral renal artery disease can be associated with hypertension with no abnormities in blood or urine. Initial onset of pheochromocytoma would be unlikely in a patient older than 65 years. In addition, this patient does not have any other signs or symptoms of pheochromocytoma, such as orthostatic hypotension. p-Adrenergic blockers could exacerbate hypertension in a patient with pheochromocytoma1 but such a presentation would be very unusual. Tachyphylaxis to propranolol is unlikely in a patient with a pulse rate of 66/minute. Increased intake of sodium is unlikely, especially in a patient without edema.
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