Differential Diagnoses for the 67-Year-Old Male Patient
Single Most Likely Diagnosis
- Resistant Hypertension: The patient has remained stage 1 to stage 2 hypertensive for the past year with no improvement using the current medication regimen, suggesting that the hypertension is resistant to treatment. The current blood pressure reading of 140/87 further supports this diagnosis.
Other Likely Diagnoses
- Hyperlipidemia: The patient's current cholesterol level is 210, and the LDL is 136, which are both elevated. Although the levels have slightly decreased from the previous readings, they are still above the desirable range, indicating hyperlipidemia.
- Suboptimal Medication Adherence: The patient's lack of improvement in blood pressure control despite being on medication for hypertension raises the possibility of suboptimal medication adherence, which could be contributing to the resistant hypertension.
- Lifestyle Factors: The patient's diet, physical activity level, and other lifestyle factors may be contributing to the elevated blood pressure and cholesterol levels.
Do Not Miss Diagnoses
- Secondary Hypertension: Although less likely, it is essential to consider secondary causes of hypertension, such as Renal Artery Stenosis, Pheochromocytoma, or Primary Aldosteronism, as these conditions can have significant consequences if left untreated.
- Cardiovascular Disease: The patient's elevated cholesterol and LDL levels, combined with the presence of hypertension, increase the risk of cardiovascular disease, including Myocardial Infarction or Stroke.
Rare Diagnoses
- Familial Hypercholesterolemia: Although rare, this genetic disorder can cause significantly elevated LDL levels and increase the risk of premature cardiovascular disease.
- Cushing's Syndrome: This rare endocrine disorder can cause hypertension, hyperlipidemia, and other metabolic abnormalities, and should be considered in the differential diagnosis, especially if other signs or symptoms are present.