DIscussion 2
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Medicine
Date
Dec 6, 2023
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docx
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Uploaded by BrigadierBear3312
1.
Differentiate between the diagnostic criteria of hypertension and isolated
hypertension.
The main diagnostic criteria difference is whether the systolic and diastolic are high versus
just systolic. Isolated hypertension is when diastolic blood pressure is less than 80mmHg, but
systolic is greater than 130mmHg. Isolated HTN can be caused by artery stiffness,
hyperthyroidism, diabetes, heart valve disorder, or obesity (Mayo Clinic 1, 2022).
Hypertension
is when systolic and diastolic are both elevated. Normal blood pressure is
measured as <120mmHg/<80mmHg. Prehypertension is noted as 120-139mmHg/80-
89mmHg. Stage 1 HTN is noted as 140-159mmHg/90-99mmHg. Stage 2 HTN is
>160mmHg/>100mmHg (Wang et al., 2017, p. 175).
It is important to note that both types of HTN are diagnosed with multiple blood pressures
over time versus just one reading.
2. Joan is a 60-year-old Asian American patient who has been managed on Losartan
50mg PO daily, Amlodipine 10mg PO daily, and HCTZ 25mg PO daily for the past two
years. Although she complies with her prescribed antihypertensive and thiazide-diuretic
medications and follows a low-sodium diet, her systolic blood pressure remains in the
170’s. In contrast, her diastolic blood pressure averages around 85. Joan was recently
diagnosed with Resistant hypertension. Discuss the pharmacological management of a
patient regarding resistant hypertension. (i.e., What medication needs to be changed (if
any)? What medication should be added and why?)
Resistant hypertension is considered high blood pressure after using three or more different
medications, with one being a diuretic (Johns Hopkins Medicine, 2022).
Joan is utilizing
three medications at this time with consistent hypertension. International Society of
Hypertension dictates the guideline for resistant hypertension is not to change any
medications but to add a low dose of spironolactone as the 4
th
line as long as serum
potassium is <4.5mmol/L. Other medications used as a 4
th
line include amiloride, doxazosin,
eplerenone, clonidine, and beta-blockers (Unger et al., 2020)
. These are used as alternatives
if spironolactone is not tolerated. Spironolactone is a potassium-sparing diuretic (Mayo
Clinic 2, 2023). It is crucial to keep an eye on electrolytes while taking multiple diuretics.
3. Deena is a 55-year-old, obese African American female with a blood pressure of
around 160/90. Her primary care provider started her on Lisinopril 5mg PO daily as a
first-line therapy, which was ineffective. Based on Deena’s ethnicity, what class of
antihypertensives would be first-line therapy and most effective for managing
hypertension, and list the treatment plan you would prescribe for her.
The African American population is known to have suppressed RAAS, alterations in renal
sodium, and early vascular aging. It also has been noted that hypertension develops at an
early age (Unger et al., 2020). Deena should be encouraged to decrease salt restriction,
increase vegetable and fruit intake, weight management, and decrease alcohol intake. The
International Society of Hypertension suggests that first-line therapy for African Americans
with hypertension combines a thiazide diuretic and a calcium channel blocker or calcium
channel blocker and angiotensin receptor blockers. Lisinopril is not suggested as a first line
because African Americans have three times more chance of angioedema with ACE
inhibitors (Unger et al., 2020). I would suggest encouraging lifestyle changes to Deena first.
If lifestyle changes are insufficient, consider a thiazide diuretic like HCTZ 12.5mg PO daily
combined with Amlodipine 2.5mg PO Daily (Arcangelo et al., 2021, pp. 298–303). Starting
at a low dose allows room to increase dosage if these are insufficient.
4. Donald is a 70-year-old patient with no significant medical history who has presented
to the local clinic on three different days for blood pressure checks. His blood pressures
were 139/90, 135/92, 140/85. Could Donald be diagnosed with hypertension (rationale)?
If so, should he be started on medication now (rationale)?
Donald’s blood pressure resides mostly in the prehypertension range. The Classification of
blood pressure is as follows:
Normal <120mmHg/<80mmHg
Prehypertension 120-139mmHg/80-89mmHg
Stage 1 140-159mmHg/90-99mmHg
Stage 2 >160mmHg/>100mmHg
(Wang et al., 2017, p. 175)
The International Society of Hypertension suggests that the patient monitor and record blood
pressure at home when blood pressure is borderline (Unger et al., 2020). I suggest he keep
track and make another office appointment in Donald's case. If his blood pressure continues
in the prehypertensive stage, I recommend lifestyle changes as the primary treatment plan. If
his blood pressure falls into the Stage 1 category after home tracking and the fourth visit, I
would initiate a low dose of Angiotensin-Converting Enzyme Inhibitors like Lisinopril 5mg
PO Daily. With Lisinopril, you can titrate the dosage every 4 to 6 weeks (Arcangelo et al.,
2021, p. 301). I would make a follow-up appointment with Donald 4 weeks after starting
Lisinopril. Note that this is based on if Donald is Caucasian. The treatment plan would
change if he were of a different ethnicity.
References
Arcangelo, V. P., Peterson, A., Wilbur, V., & Reinhold, J. A. (2021).
Pharmacotherapeutics for
Advanced Practice
(5th ed.). Wolters Kluwer.
Johns Hopkins Medicine. (2022, March 10).
Resistant hypertension
. Retrieved September 24,
2023, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/high-blood-
pressure-hypertension/resistant-hypertension
Mayo Clinic 1. (2022, June 9).
Isolated Systolic Hypertension: A health concern?
Mayo Clinic.
Retrieved September 24, 2023, from https://www.mayoclinic.org/diseases-
conditions/high-blood-pressure/expert-answers/hypertension/faq-
20058527#:~:text=Isolated%20systolic%20hypertension%20happens
%20when,130%20mm%20Hg%20or%20higher.
Mayo Clinic 2. (2023, September 7).
Spironolactone (Oral route)
. Mayo Clinic. Retrieved
September 24, 2023, from https://www.mayoclinic.org/drugs-
supplements/spironolactone-oral-route/description/drg-20071534
Unger, T., Borghi, C., Charchar, F. J., Khan, N., Poulter, N., Prabhakaran, D., Ramiréz, A. J.,
Schlaich, M. P., Stergiou, G. S., Tomaszewski, M., Wainford, R. D., Williams, B., &
Schutte, A. E. (2020). 2020 International Society of Hypertension Global Hypertension
Practice Guidelines.
Hypertension
,
75
(6), 1334–1357.
https://doi.org/10.1161/hypertensionaha.120.15026
Wang, V. J., Joing, S. A., Fitch, M. T., Cline, D. M., John, O., MA, & Cydulka, R. K. (2017).
Tintinalli’s Emergency Medicine Manual, Eighth Edition
(8th ed.). McGraw-Hill
Education / Medical.
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