Diagnosis at Hypertensive Urgency with Possible Hypertensive Encephalopathy
Ang pasyente ay may hypertensive urgency na may mga sintomas ng hypertensive encephalopathy (sakit ng ulo, pagkahilo, pagsusuka) at nangangailangan ng immediate assessment para sa acute organ damage at dose adjustment ng antihypertensive medication. 1, 2
Medical Assessment
Diagnosis
Hypertensive Urgency na may sintomas ng hypertensive encephalopathy - ang BP ay 180/110 mmHg kahapon at 150/90 ngayon, kasama ang sakit ng ulo ng 3 araw, pagkahilo, at pagsusuka, habang maintained sa Amlodipine 10mg 1, 2
Critical Assessment Needed
Ang mga sumusunod ay kailangan suriin upang malaman kung ito ay hypertensive emergency (na nangangailangan ng ICU admission) o hypertensive urgency lamang:
- Neurologic examination - tingnan kung may lethargy, seizures, altered consciousness, o focal neurologic deficits na nagpapahiwatig ng hypertensive encephalopathy 1, 2
- Fundoscopy - hanapin ang flame hemorrhages, cotton wool spots, o papilledema na nagpapahiwatig ng malignant hypertension 1, 2
- ECG - para suriin kung may acute coronary syndrome 1, 2
Probable Cause
Ang pinaka-common na dahilan ng hypertensive urgency ay medication non-adherence o inadequate BP control sa current dose ng Amlodipine 10mg 3
Plan and Recommendations
Immediate Management
Kung walang acute organ damage (normal neurologic exam, walang papilledema, normal ECG):
- Dagdagan ang Amlodipine dose - ang kasalukuyang 10mg ay maximum dose na, kaya kailangan ng additional antihypertensive agent 4
- Target BP reduction: Huwag sobrang bilis na ibaba ang BP - target ay 25% reduction within first hour, then to 160/100 mmHg within 2-6 hours 1, 2, 3
Medication Prescription (PhilHealth Konsulta Formulary)
Losartan 50mg tablet
- Dose: 1 tablet once daily sa umaga
- Dispense: 30 tablets
- Duration: 30 days
- Estimated cost: ₱90-120
Amlodipine 10mg tablet (continue current dose)
- Dose: 1 tablet once daily
- Dispense: 30 tablets
- Duration: 30 days
- Estimated cost: ₱60-90
Paracetamol 500mg tablet (para sa sakit ng ulo)
- Dose: 1-2 tablets every 6 hours as needed
- Dispense: 20 tablets
- Duration: as needed for headache
- Estimated cost: ₱20-40
Total estimated cost: ₱170-250 (within 300 pesos budget)
Rationale for Adding Losartan
- Ang combination ng calcium channel blocker (Amlodipine) at ARB (Losartan) ay mas effective kaysa monotherapy para sa BP control 1
- Ang Amlodipine 10mg ay maximum dose na, kaya kailangan ng additional agent 4
- Ang Losartan ay available sa PhilHealth formulary at cost-effective 1
Important Warnings and Follow-up
Red flags na kailangan immediate ER referral:
- Severe headache with neurologic symptoms (confusion, seizures, vision loss) 1, 2
- Chest pain o severe shortness of breath 1, 2
- Sudden vision changes 1, 2
Follow-up:
- Bumalik after 2-4 weeks para i-assess ang response sa bagong medication 2
- Monitor BP at home kung possible - target ay <140/90 mmHg 1
- Kung hindi bumaba ang BP after 2 weeks, possible referral for further workup ng secondary hypertension 3
Lifestyle Modifications
- Bawasan ang salt intake 1
- Regular exercise kung cleared 1
- Iwasan ang alcohol at smoking 1
- Maintain healthy weight 1
Medical Certificate
This certifies that patient has been seen and examined today with the diagnosis of:
Hypertensive Urgency with symptoms of hypertensive encephalopathy (headache, dizziness, vomiting) secondary to inadequately controlled hypertension
Recommendation:
Rest for 3-5 days with close BP monitoring. Medication adjustment initiated. Patient advised to return to work/school after BP stabilization and symptom resolution, with follow-up in 2-4 weeks. Not yet fit to work until BP is controlled and symptoms resolve.
This medical certificate is issued upon the request of the patient for: sick leave from work due to uncontrolled hypertension requiring medication adjustment and close monitoring.