Case Histories in Human Physiology - Cardiovascular Case Histories

Cardiovascular Case Histories - Case 14

A 5'6", 210 lb., 64-year-old male business executive had a physical exam prior to his retirement from corporate work. His blood pressure was >180/115 on three separate days. Further examination showed normal to low plasma renin activity, elevated total peripheral resistance (TPR), cardiac output (CO) of 7.2 L/min, x-ray evidence of left ventricular hypertrophy, retinal hemorrhages, and mild polyuria. Recommended therapy was weight reduction to his ideal level, a low-salt diet (<2 gm/day sodium), prudent exercise, and a reduction in alcohol consumption (<3 oz whiskey/day). This change in lifestyle did little to change the condition. Medication was initiated in the form of an oral diuretic and progressed to a beta-blocker; eventually a vasodilator was included to reduce the blood pressure to <140/90.

1. What is the diagnosis for this individual?

2. What should this individual's ideal body weight be? (Assume he is of medium body frame.)

3. Explain the sites of action for the three pharmacologic agents prescribed for this individual.
Oral diuretic:
Beta-blocker:
Vasodilator:

4. Why was the vasodilator not used before the other drugs were added?

5. Outline the usual steps in the medical treatment of hypertension.

6. What was the cause of the retinal hemorrhages?

7. Define and indicate the causes of the cardiac hypertrophy and polyuria.

8. Write the formulas for determining mean arterial blood pressure, blood pressure, and pulse pressure.
MABP =
BP =
PP =

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