Introduction: Though hypertension is one of the most prevalent and universal medical diagnoses, approximately 50% of patients do not achieve adequate BP control. Uncontrolled HTN has many known complications, such as heart failure, stroke, kidney disease, and myocardial infarction. However, there are far fewer incidences of GI complications, such as GI bleed, relating to uncontrolled HTN.

Case Presentation: We present a 63-year-old male poor historian with history of HTN and noncompliance with medication, presenting with episodes of confusion and recurrent falls. He had been to the ER the day prior to admission with BP 195/145 after being found on the floor due to a fall, laying in his own urine and feces; however, he left AMA without a complete work-up. Family then brought him back to the hospital for similar disorientation and inability to care for himself. Family confirmed he takes no medications at home. His CBC revealed Hb 5.8 and Hct 16.9%. Brain MRI showed cerebral atrophy with prior chronic brainstem infarcts.

During his hospitalization, he required multiple investigations. First, on day 4 of hospitalization, patient became unresponsive/pulseless in PEA, and required 15 minutes of CPR before successful ROSC, intubation, and ICU transfer. Subsequent ECG revealed STEMI, so Cardiology performed heart catheterization with multiple unsuccessful PCI attempts and no reflow distally. Second, his original presentation with recurrent falls and the low H&H on admission suggested an upper GI bleed. EGD was performed, revealing multiple ulcers in the stomach and duodenum, one required clipping to prevent continued bleeding.

Diagnosis: Patient was diagnosed with hypertensive encephalopathy due to medication noncompliance, complicated by acute GI bleed secondary to gastric and duodenal ulcers. Management/Outcome: Patient received multiple PRBC transfusions, antibiotics, volume repletion, anticoagulants, and antihypertensives. His GI bleed without H. Pylori diagnosis or NSAID use suggested that his uncontrolled HTN caused gastroduodenal ischemia leading to bleeding peptic ulcers—a rare complication. Though this was able to be treated, his many years of noncompliance presented subsequent organ dysfunctions throughout his hospital stay that could not be reversed. Ultimately on day 17, patient expired due to STEMI after family agreed to make him DNI/DNR.

References

1. https://www.uptodate.com/contents/patient-adherence-and-the-treatment-of-hypertension?search=hypertension&topicRef=3852&source=see_link
2. https://www-uptodate-com.acom.idm.oclc.org/contents/peptic-ulcer-disease-epidemiology-etiology-and-pathogenesis?search=ulcer%20causes&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3#H6
3. https://www.uptodate.com/contents/the-prevalence-and-control-of-hypertension-in-adults?search=hypertension&topicRef=3852&source=see_link#H2
4. https://www-uptodate-com.acom.idm.oclc.org/contents/unusual-causes-of-peptic-ulcer-disease?search=ulcer%20causes&topicRef=22&source=see_link#H21