From the Guidelines
The patient's current medication regimen appears to be effective in managing her blood pressure fluctuations, and continued monitoring is warranted given her complex medical history and recent completion of radiation therapy. The patient is a 76-year-old female with an extensive medical history including carotid endarterectomy, fatty liver, hypertension, pre-diabetes, hepatic steatosis, GERD, cholecystectomy, and breast cancer. She recently completed radiation therapy for breast cancer on May 1,2025. During recent office visits, she has experienced episodes of hypotension. The patient reports only one instance of elevated blood pressure above 140/90, which prompted her to take her antihypertensive medication. She has scheduled follow-up appointments with Dr. Close and the radiation nurse for continued monitoring. The patient mentions that she has been taking medication in the afternoon which has been effective in reducing her stress levels. According to the 2007 guidelines for the management of arterial hypertension 1, the goal blood pressure should be < 140/90 mmHg, and antihypertensive drug treatment may be started already when blood pressure is in the high normal range. Additionally, the 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease 1 recommends antihypertensive treatment for patients with hypertension and symptomatic extracranial carotid or vertebral atherosclerosis, but the benefit of treatment to a specific target blood pressure has not been established in relation to the risk of exacerbating cerebral ischemia. Given the patient's complex medical history and recent completion of radiation therapy, it is essential to continue monitoring her blood pressure and adjusting her medication regimen as needed to minimize the risk of cardiovascular complications. The patient's medication regimen should be tailored to her individual characteristics, and the choice of antihypertensive medication should be based on her specific needs and medical history, as recommended by the 2007 guidelines for the management of arterial hypertension 1. Overall, the patient's current medication regimen appears to be effective in managing her blood pressure fluctuations, and continued monitoring is warranted given her complex medical history and recent completion of radiation therapy.
From the Research
History of Present Illness
The patient is a 76-year-old with a complex medical history, including:
- Carotid endarterectomy
- Fatty liver
- Hypertension
- Pre-diabetes
- Hepatic steatosis
- GERD
- Cholecystectomy
- Breast cancer She recently completed radiation therapy on 5/1/25 and has reported experiencing hypotension during recent office visits.
Current Symptoms and Medications
The patient reports:
- Only needing to take her blood pressure medication due to slight elevation over 140/90, which occurred only once
- Taking medication in the afternoon, which is helping reduce stress levels
- Having follow-up appointments scheduled with Dr. Close and the radiation nurse
Relevant Studies
Studies have shown that:
- Hypertension is a leading cause of cardiovascular disease morbidity and mortality, and first-line therapy includes lifestyle modification and medication 2
- Radiation-associated hypertension can occur in patients undergoing radiation therapy, and may require additional medication 3
- Combination therapy is often necessary for managing hypertension, and the timing of medication intake can affect blood pressure control 4, 5
- However, these studies may not be directly relevant to the patient's current situation, as they do not specifically address the patient's complex medical history and recent radiation therapy.