Primary Diagnosis: Essential hypertension: This also known as primary hypertension. It is the
type of hypertension without an identifiable cause. ICD10
... [Show More] CODE: - I10
Second Primary diagnosis: Sleep Apnea unspecified. ICD 10 CODE-G47.30: Mr. Harvey
symptoms are pointing out towards an obstructive sleep apnea (OSA). Some of the symptoms are
the daytime somnolence, morning headache. That may be contributing to his hypertension
diagnosis.
3 Differential Diagnosis
Secondary hypertension: This should be described as a hypertension caused by another
medical condition. That means that the elevated blood pressure results from identifiable
underlying condition could be led to diagnosis of secondary hypertension. (Domino, et al,
2021). Since Mr. Harvey has an undiagnosed sleep apnea for so long, that might be the
cause of the elevated blood pressure. (Domino, et al, 2021), states that the most common
secondary cause of high blood pressure in elderly are sleep apnea, renal disease, renal
artery stenosis, and primary aldosteronisms (PA).
White coat/pseudo resistant hypertension: This is an elevation of blood pressure in
office setting, and lower BP level outside the office. Sometimes, this mostly caused by
anxiety or nervousness. (Buttaro, et al 2019). Looking into Mr. Harvey’s history, his
blood pressure elevated whenever he is with a doctor or a nurse. There is no record to
shows that he has had an elevated BP at home. So, there is a probability that he was
having a white coat hypertension. This can be ruled out with the associated symptoms,
and diagnostic test results.
Masked Hypertension: This is when the BP is high at home, and low in the office.
(Domino, et al 2021,) This can be easily ruled out by making sure that the patient uses a
good home blood pressure machine and know exactly how to perform a blood pressure
check.
.
Additional laboratory test and diagnostic
Comprehensive metabolic panel (CMP)
Complete Blood count (CBC)
12 lead ECG
Chest x-ray PA & Lateral
Free thyroxin (FT4)
Complete urinalysis 9may reveal protein)
Lipid panel
Fasting Glucose or Hemoglobin A1c.
Echocardiogram, Transthoracic (TTE)
Polysomnography/sleepy study, to check for sleep apnea.
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Consults:
Somnologist for sleep apnea and for a possible CPAP machine.
Nutritionist/Dietitian
Cardiologist due to the finding of displaced PMI. It might be a cardiomegaly.
Therapeutic Modalities: Non-Pharmacological
Lifestyle modification; re [Show Less]