Management of Well-Controlled Hypertension with New-Onset Allergic Conjunctivitis
Continue the current antihypertensive regimen without modification and treat the allergic conjunctivitis with topical antihistamine/mast cell stabilizer combination eye drops.
Hypertension Management
Your patient's blood pressure is well-controlled and requires no intervention at this time:
Home BP readings demonstrate excellent control with systolic values ranging 116-144 mmHg, and today's clinic reading of 136/73 mmHg confirms this 1, 2
The current triple-drug regimen (bendroflumethiazide 2.5mg, losartan 100mg, betaloc 47.5mg) should be continued unchanged 1
Target BP for this elderly patient is <130/80 mmHg per ACC/AHA guidelines, though <140/85 mmHg is acceptable for older adults 1
The home readings consistently meet these targets, and the slightly elevated clinic reading (136 systolic) likely represents white coat hypertension as the patient suspects 1
Follow-up Monitoring
Continue home BP monitoring with pre-medication morning readings to track trends 1
No need for monthly visits given the excellent control already achieved 2
Allergic Conjunctivitis Management
The watery eyes without itching, pain, or erythema suggest mild allergic conjunctivitis:
First-line treatment is topical antihistamine/mast cell stabilizer combination drops (e.g., olopatadine, ketotifen) 1-2 drops twice daily to both eyes 4, 5, 6
These multi-action agents are superior to polytears (artificial tears) which only provide mechanical lubrication without addressing the underlying allergic inflammation 5, 6
Avoid topical corticosteroids initially despite their effectiveness, as they carry significant risks of cataracts and glaucoma, particularly in elderly patients 7, 8
Corticosteroids should be reserved only for severe cases with corneal involvement, photophobia, or pain—none of which are present here 4, 6, 8
Treatment Duration and Escalation
Trial the antihistamine/mast cell stabilizer drops for 2-4 weeks 5, 6
If symptoms persist despite compliance, consider adding oral antihistamines for moderate cases 5
Return immediately if symptoms worsen, develop eye pain, photophobia, or vision changes, as these suggest progression to more severe forms requiring specialist referral 4, 6
Common Pitfalls to Avoid
Do not use topical decongestants long-term (e.g., naphazoline, tetrahydrozoline) as they cause rebound hyperemia and tachyphylaxis 5
Do not assume polytears failure means treatment failure—artificial tears do not treat allergic inflammation and were an inappropriate initial choice 5, 6
Do not delay appropriate antiallergic therapy while waiting for allergological testing, as clinical diagnosis based on history and examination is sufficient for mild cases 4, 6