Cardiologie clinique et expérimentale
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The Risk of Sudden Decrease of Severe Arterial Hypertension

Manuela Stoicescu

Objectives: The main objective of this clinical case presentation is to attract attention about the dangerous risk of sudden decrease of the value of blood pressure in hypertensive patients with severe value of blood pressure.
Methods: I present the clinical case of a woman patient 61 years old, hypertensive, with severe value of blood pressure (BP=210/110 mmHg) with a therapeutic scheme at home with Metoprolol 2 × 25 mg/day and Lisinopril 2 × 5 mg/day, but without a good response and control of the value of blood pressure (BP=180/90 mmHg). For this reason the patient was investigated very carefully in direction of secondary hypertension, but all the investigations were normal and nothing was found like a cause of this. Because the value didn’t decrease to come in normal range after this therapeutic scheme, the patient goes one day to the Emergency Department because after she administrated at home the dosages of medications, the value of blood pressure maintain high 200/100 mmHg. In the Emergency Department they administrated 1 drug of Captopril 25 mg and one ampoule of Furosemid i.v. , but after one hour because the value of blood pressure remained the same 200/100 mmHg, was administered once again a ampoule of Furosemid i.v. and unexpected the patient present a lypothimia with arterial hypotension (BP=70/40 mmHg) and surprising severe bradycardia=30 bates/min, immediately was administrated ½ of ampoule of atropine i.v. and after 5 minutes the value of blood pressure become BP=160/80 mmHg and HR=74 bates/min.
Results and discussions:
1. A vagal reaction could be possible because of sudden decrease of the value of blood pressure?
2. A posterior-inferior myocardial infarction could be possible, but the normal image of EKG and normal level of Troponin I=0.01 ng/mL and CPKMB=4.2 ng/mL excluded this possibility.
3. Unstable angina pectoris was excluded because the patient didn’t have chest pain and missed ischemic-lesion changes on EKG.
4. Suspicion of a possible sick sinus syndrome? The patient, after Holter monitorization, presented a pass of brady-tachy syndrome confirmed safe the diagnosis of sick sinus syndrome and performed a pacemaker implantation with good evolution.
Conclusion: The therapy of arterial hypertension must be personalized and sudden decrease of the value of high blood pressure is very dangerous with patients with an unknown sick sinus syndrome, because it can develop to an unexpected severe bradycardia.