Yesterday I saw a patient who was a diabetic with diabetic nephropathy, CKD-5D, on maintenance HD. He had a dry gangrene in the right foot. Significant peripheral vascular disease, with loss of racial pulse in the right hand. However, his blood pressure at the brachial in the right was >300 mm Hg. Could not confirm on the left side to an av fistula at that side.
I refuse to believe that the observation is correct. I am sure of the reading and the apparatus. Please come up with explanation how this is possible in an otherwise asymptomatic patient (no features of hypertensive emergency).
