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Ambulatory Blood Pressure Monitoring.

Tamar Polonsky, George L Bakris
Published 2018 · Medicine
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A65-year-oldwoman presented to her primary care physicianwith concerns about large fluctuations in her blood pressure (BP). The patient’s home BPmeasurements were often lower than 120/80 mm Hg but sometimes reached 200/100 mm Hg. She had a non–STsegment elevationmyocardial infarction 1 year ago and was treated with a drug-eluting stent in her right coronary artery. Her antihypertensive medications includedcarvedilol (12.5mg, twicedaily), lisinopril (40mg daily), and chlorthalidone (12.5 mg daily). Additionally, the patient had generalized anxiety and panic disorders (treatedwith paroxetine, 30mg), and she smoked for 90pack-years but quit 2months ago. Thepatient’s office BPmeasurement was 127/74mmHg. Her physical examination was unremarkable. Twenty-four-hour ambulatory BP monitoring was performed to evaluate patterns of elevated BP and potential etiologies. The patient kept a log of her diet, sleep pattern, and symptoms. Mean BP levels were 133/86 mm Hg overall (normal, <130/80 mm Hg); daytime, 135/88 mm Hg (normal, <135/85 mm Hg); and sleeping, 124/78 mm Hg (normal, <120/70mmHg).During the first sudden increase inBP(04:00-06:00;Figure), sheawoke from sleepwith a panic attack. The second sudden increase (07:00-10:00) occurred after eating a high-sodium breakfast.
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