Cardiovascular Case Study1
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California Baptist University *
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Health Science
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Dec 6, 2023
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Cardiovascular Case Study
A 55-year-old man with a history of diabetes mellitus type 2 comes to your clinic for a 1-month
follow-up visit. His blood pressures in the last 2 visits have been 145/90, 140/85, 140/90, and
135/90 mm Hg. Today his blood pressure shows similar numbers. You explain to the patient that
he likely has hypertension and appropriate management is important to prevent complications.
He reports being a truck driver and eats on the road a lot. He is sedentary most of the day due to
his job. His BMI is 30.
Important considerations will include blood pressure target lifestyle modifications, medical
therapy, medications, and additional testing. Based on the information provided and the
management goals for this patient, answer the following questions. You may also want to read
the following ACC/AHA guidelines:
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.107.183885?url_ver=Z39.88-
2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
1.
What are his risk factors for complications?
-
DM II
-
HTN
-
Poor diet
-
Sedentary lifestyle
-
Obese
-
Male
2.
What is his target BP based on the ACC/AHA guidelines?
-
BP <130/80
-
Based on pt’s age
3.
What lifestyle changes would you recommend? What education or specific instructions
would you need to provide to the patient?
-
Diet & lifestyle
o
Exercise 30 min a day, walking, biking etc
o
Decrease the amount of fast food on the road
o
Increase amount of fruits and vegetables
-
Low sodium diet
o
DASH
-
Medication compliance
-
Attend follow up appointments
4.
Considering the ACC/AHA guidelines what medications would be preferred HTN
treatment for diabetics and why?
-
Thiazide diuretics:
o
To decrease sodium absorption and decrease water absorption
-
ACE inhibitors
o
Blockers of RAS
-
Calcium channel blockers
o
Inhibits movement of calcium across cell membranes
o
Muscle relaxing > vasodilation
5.
Give MOA
and describe the PK PD, common side effects, drug-drug interactions,
for Ace
inhibitors and ARB’s?
-
ACE: lisinopril
o
Block the conversion of angiotensin I to the vasoconstrictor angiotensin II
o
Prevent the degradation of bradykin and other vasodilatory prostaglandins
o
100% eliminated by the kidneys
o
25% absorbed followed oral administration
o
Onset is 1 hour, peak 6 hours, and duration 24 hours
o
Contraindications: angioedema, pregnant women
o
SE: angioedema, dizziness, cough
o
Drug interactions: concurrent use with sacubitril increases risk of angioedema
-
ARB: losartan
o
Blocks the vasoconstrictor and aldosterone secreting effects of angiotensin II
at various receptor sites including vascular smooth muscle
o
Undergoes first pass hepatic metabolism resulting in 33% bioavailability
o
Onset is 6 hours, peak is 3-6 weeks, duration is 24 hours
o
Contraindication in pregnant or lactating women
o
SE: diarrhea, angioedema
o
Drug interactions: excessive hypotension with use of other antihypertensives
or diuretics
o
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