Our patient is a 45 year old man who is referred for the evaluation of his hypertension. He had recently applied for life insurance, and his application was turned down.
The patient stated he generally felt well, but wanted to get some life insurance. He was told his blood pressure was very high, and the reading was confirmed three separate times.
He stated that his last check-up was at the age of 27, when he was discharged from the military. He was told his blood pressure was borderline elevated, and advised to undergo follow-up evaluation. Since he felt well, he sought no further medical care.
When specifically asked, he said he was mildly short of breath with exertion. He ascribed this to "being out of shape."
He owned a small electronics company, and his work was usually sedentary. If he had to lift heavy boxes of supplies, he became breathless. His favorite pastime, bowling, caused no problem. He had no orthopnea or nocturnal dyspnea.
He also stated he had headaches in the evening, especially since he was turned down for life insurance.
There is no history of chest pain, heart murmur, syncope or weakness. He has had no paroxysmal episodes of palpitations, sweating or abdominal pain.
He denied polyuria or any history of renal disease. He also denied taking prescribed, over the counter or illicit drugs.
His additional history revealed that his father and a younger brother have hypertension, and his father had a stroke at the age of 65.
Over the last ten years, the patient's weight increased thirty pounds. He follows no diet, freely adds salt to his food, and has no exercise program.
He drinks two beers daily and has several more on weekends. He smokes a package of cigarettes per day, and has since he was a teenager.