A 65-year-old woman presented to her primary care physician with concerns about large fluctuations in her blood pressure (BP). The patient’s home BP measurements were often lower than 120/80 mm Hg but sometimes reached 200/100 mm Hg. She had a non–ST-segment elevation myocardial infarction 1 year ago and was treated with a drug-eluting stent in her right coronary artery. Her antihypertensive medications included carvedilol (12.5 mg, twice daily), lisinopril (40 mg daily), and chlorthalidone (12.5 mg daily). Additionally, the patient had generalized anxiety and panic disorders (treated with paroxetine, 30 mg), and she smoked for 90 pack-years but quit 2 months ago. The patient’s office BP measurement was 127/74 mm Hg. Her physical examination was unremarkable.
Polonsky TS, Bakris GL. Ambulatory Blood Pressure Monitoring. JAMA. 2018;320(17):1807–1808. doi:10.1001/jama.2018.14856
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