Medical History

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Any prior diagnosis of hypertension, including treatment regimens, compliance patterns, and baseline recordings of past blood pressures, are important to determine. Elevated blood pressure in the context of several months of noncompliance with antihypertensive medications likely represents a patient's baseline, whereas hypertension after several days of noncompliance could be a more serious abrupt cessation syndrome. A history of all medication use, including over-the-counter and illicit drugs, should be obtained, since many commonly used agents—including cocaine, amphetamines, decongestants, stimulants, oral contraceptives, and nonsteroidal anti-inflammatory drugs (NSAIDs)—may elevate blood pressure. MAO inhibitors in combination with tyramine-containing foods (e.g., beer and aged cheese) or certain drugs (e.g., amphetamines and tricyclic antidepressants) can also precipitate acute blood pressure elevation. Any past medical history of cardiovascular, cerebrovascular, or renal disease; diabetes; hyperlipidemia; chronic obstructive pulmonary disease (COPD); asthma; or gout; or a family history of hypertension or premature heart disease should also be elicited.1 Patients with elevated pressures should be asked specifically about CNS symptoms (e.g., headache, diplopia, blurred vision, confusion, hemiparesis, and seizures), cardiac symptoms (e.g., chest pain, dyspnea, tachycardia, and palpitations), and renal symptoms (e.g., hematuria and anuria) that may be indicative of progressive end-organ damage.1

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