On June 1st, 2022, a 63-year-old black male farmer was brought to the emergency room with symptoms of disorientation and breathing difficulties. The patient was brought into the emergency room four hours earlier with significant anterior nose bleeding. The physician took the patient's blood pressure and discovered that it was 196/113 mmHg based on the patient's historical history after his caregivers informed him of his previous medical and drug histories. The physician recommended tranexamic acid 1 g intravenously three times a day for two days after the blood pressure was checked and determined to be raised without any laboratory investigations, physical examinations, or imaging evaluation. The patient had a sixteen-year history of type 2 diabetes mellitus and a nine-year history of hypertension. The patient was treated for his prior type 2 diabetes mellitus with metformin and glibenclamide. He used enalapril and furosemide for his prior hypertension. He had previously smoked cigarettes and consumed alcohol. Five years prior, he gave up drinking alcohol and smoking cigarettes. Due to the patient's failure to take his antihypertensive medications consistently during the previous six months, atenolol was added to his treatment regimen. The patient who was admitted had no prior medical or drug history in his family. The patient's hypertensive urgency is a direct result of forgetting to take his blood pressure management drugs and of not adhering to his previous antihypertensive drugs as prescribed. The patient was hospitalized after exhibiting symptoms of breathlessness, malaise, nausea, and vomiting. The patient lost consciousness and lost motor function while traveling to the village for a two-day business trip and left his medicine at home.
At the time of admission, his vital signs included a high blood pressure of 196/113 mmHg, a heart rate of 93 beats per minute, a body temperature of 35.8  C, a respiratory rate of 20 breaths per minute, a height of 1.70 m, a weight of 83 kg, a body mass index of 28.7 kg/m2, and an oxygen saturation of 91% on room air. Up on his admission blood chemistry of the patient revealed: blood urea nitrogen of 29 mg/dL (normal value: 6-20 mg/dL), potassium of 3.7 mmol/L (normal value: 3.6-5.2 mmol/L), sodium of 168 mEq/L (normal value: 135-145 mEq/L), fasting blood glucose of 134 mg/dL (normal value: 100-126 mg/dL), 2-hour postprandial blood glucose of 203 mg/dL (normal value: 140-180 mg/dL), higher density lipoprotein of 59 mg/dL (normal value: 40-60 mg/dL), lower density lipoprotein of 130 mg/dL (normal value: 100-129 mg/dL), triglycerides of 145 mg/dl, (normal value: < 150 mg/dL), tests for coagulation are normal, hemoglobin of 13.5 mg/dL (normal value: 13.8-17.2 mg/dL), hematocrit of 37% (normal value: 41-50%), and serum creatinine of 1.4 mg/dL (normal value: 0.7-1.3 mg/dL), urinalysis revealed urine crystals, white blood cell of 11,340 cells/mm3 (normal value: 4500-11,000 cells/mm3), neutrophils of 67% (normal value: 55-70%), and lymphocytes of 27% (normal value: 20-40%).
His cardiac auscultation revealed that he had not have elevated jugular venous pressure, crackles, and gallops in addition to no heart murmurs in S1 and S2. An abdominal examination revealed no edema and a link to some minor epigastric discomforts. Pink conjunctiva was discovered during a head, ear, eye, nose, and throat examination. During the neurological examination to determine his degree of awareness, it was found that he was unconscious and had eyesight problems (blurred vision rather than optic neuritis). The right arm received a score of 3/5, the right leg received a score of 3/5, the left arm received a score of 2/5, and the left leg received a score of 3/5 on the Glasgow Coma Scale, which was used to measure level of consciousness. On the Glasgow Coma Scale, the patient received an overall score of 11 out of 15. Lung auscultation revealed no pulmonary edema and minute crackles in the respiratory system. Even though the electrocardiogram (ECG) showed a rapid heartbeat, there was no sign of an arrhythmia or a change in the ventricular repolarization of the anterolateral wall. The electrocardiogram's readings were normal, and the adjusted QT interval was 0.78 seconds. Chest X-rays revealed an aberrant cardiac area (which shows the length of the cardiac cycle is changed without a compensatory change in the length of the refractory period), although the pulmonary parenchyma and fluid overload were unaffected. Magnetic resonance imaging, an echocardiogram, and a computed tomography scan of the brain are all clear. There is no sign of any bruising or petechiae that could point to an underlying hematologic disorder.
After taking tranexamic acid for 48 hours, the patient was able to recover from epistaxis. He had received doses of 5-20 mg of intravenous labetalol, which effectively treated his hypertensive urgency and rebound hypertension. The patient's intravenous labetalol and previous enalapril were switched to captopril 25 mg orally three times until hypertensive urgency was managed after he began taking the medication orally. In addition to his existing hypertension medication regimen, which included furosemide, atenolol, and captopril, the physician added amlodipine 5 mg orally, once daily for 30 days. The patient was instructed to engage in regular aerobic exercise as well as follow a dietary approach to prevent hypertension.
He was observed for seven days in the medical ward, and by day 10, he had significantly improved. His heart rate dropped to 78 beats per minute, and his blood pressure recovered to 149/97 mmHg after 10 days. He returned home after being discharged. He was advised to have a monthly ambulatory care follow-up.