Blood Pressure Monitoring Challenges in a 68-Year-Old Female Patient

Case at a Glance

A 68-year-old female with pre-diabetes and osteoarthritis presents with newly elevated blood pressure readings showing significant variability between clinical and home measurements.

Patient's Story

The patient is a 68-year-old female, height 5'3", weight 185 lbs, with a medical history of pre-diabetes and osteoarthritis. She is currently taking Lexapro daily. Throughout her medical history, she has maintained consistently normal blood pressure readings, which surprised her healthcare providers. However, starting in late spring of the current year, she began experiencing elevated blood pressure measurements.

Initial Assessment

During clinical visits, initial blood pressure readings have been elevated, with the highest recorded at 165/80 mmHg at an urgent care facility. Upon retesting during the same visit, readings typically decreased to the 150s mmHg range or returned to normal levels. This pattern of initial high readings followed by lower subsequent readings has been consistently observed across multiple healthcare encounters.

The Diagnostic Journey

Due to the variability in blood pressure readings and the recent onset of hypertension, her physicians recommended home blood pressure monitoring for better assessment. The patient was instructed to maintain a log of her home measurements using a standard upper arm cuff monitor. However, she reports inconsistent readings at home, with measurements fluctuating between high and low values, and occasional equipment malfunctions.

Final Diagnosis

White coat hypertension with possible underlying essential hypertension requiring further monitoring and evaluation.

Treatment Plan

Continued home blood pressure monitoring with proper technique education, including: sitting quietly for 5 minutes before measurement, feet flat on floor, arm at heart level, avoiding caffeine and tobacco prior to measurement. Regular follow-up appointments scheduled to review home monitoring logs and determine need for antihypertensive therapy.

Outcome and Follow-up

Patient education provided regarding proper use of home blood pressure monitors and factors affecting accuracy. Emphasis placed on technique standardization and consistent timing of measurements. Ongoing monitoring planned to differentiate between white coat hypertension and true hypertension requiring pharmaceutical intervention.