CaseStudy_Hypertension final
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Regis College *
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641
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Medicine
Date
Jan 9, 2024
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docx
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4
Uploaded by audyw44
Hypertension Case Study
Darius, a 65-year-old Black man, was referred to the clinic for evaluation of high blood pressure. Upon assessment the patient blood pressure at his last appointment was 168/92, today his blood pressure is 142/88. Patient is experiencing headaches and increased urination at
nighttime. In addition to those symptoms, he has gained 8 pounds this year. Patient has a history of diabetes and is currently taking 25mg of empagliflozin daily. The patient could be prescribed an Ace Inhibitor. However, the patient should avoid diuretics due to certain diuretics causing hyperglycemia and the patient has a diagnosis of diabetes. Since the patient is African American and has diabetes another option to use would be a calcium channel blocker. It has been proven that using Calcium channel blockers and/or diuretics are an effective treatment for hypertension in Black patients (Onakpoya, 2020). According to the FDA It is okay for a diabetic patient to use an ace inhibitor, but they should still be monitored (Goyal et al., 2023). The patient will be prescribed to start 10 mg of Lisinopril PO Daily.
Upon discharge the patient will be educated the signs and symptoms of using ace inhibitors as treatment. It is important to let our patients know what the medication is for and why is he taking it. The goal of ace inhibitor therapy is to decrease and maintain the patient’s blood pressure. In addition to taking medication therapy this provider will educate the patient on lifestyles changes to incorporate in his life featuring a low sodium diet, utilizing the DASH diet, decrease any alcohol intake and increase in exercise therapy. In addition, it is important to educate the patient on the overall effects of antihypertensive medication and that when taking This document is property of Regis College.
an antihypertensive there is an increased risk for having possible side effects that include headaches and dizziness. Ace inhibitors should not be paired with potassium sparing diuretics due risk of causing hyperkalemia (Khalil & Zelser, 2023). The patient should be aware of when to seek doctors’ advice this will include if the patient has a cough developed after taking the medication, notices any swelling or issues with urination. Ace Inhibitors are known for their side effects that include an ace cough, renal insufficiency and the risk of angioedema which effects the deep tissue, this can be life threatening (Khalil & Zelser, 2023). If the patient reports having an intolerable ace cough or angioedema a change in medication therapy will be completed. In the next 14 days if the patient is still experiencing high blood pressures it is important to alter the doses if necessary or
switch to a different medication regimen. Due to the patient’s labs showing hyperlipidemia it is a good choice for the patient to start a statin especially due to the patient having a preexisting condition of hypertension. The American Association of Cardiology created a risk tool the measure the lifetime and 10year risk of an individual to guide in the best treatment (American College of Cardiology, n.d) . According to the ASVD scale the current patient has a 10-year risk factor of 34.3%. With a risk factor of 34.3% it is advised that the patient be started on a high-risk statin therapy. The patient will be started on Atorvastatin 80 mg PO Daily. It is important to educate this patient on the signs and symptoms of myopathy due to the patient taking medication for his diabetes as well. There is a possibility that the diabetic medication can increase the concentration of Atorvastatin causing the patient to experience muscular pain which would lead to a change or altering of therapy. This document is property of Regis College.
The patient should also be advised to stay away from grapefruit juice and substitute it for another juice due to the interactive effects. In addition to statin therapy lifestyle modifications and treatment of other preexisting diagnosis are important. The patient should work on having a healthier diet, exercise and cutting down on any alcohol or smoking if applicable. This patient should also maintain and be compliant with their antihypertensive therapy. As state previously it is important that the patient is aware of the risk of myopathy and renal insufficiency. The patient should report any changes in urine or renal functions noticed. Patient should also report
if they feel an onset of muscular discomfort or pain. These symptoms can lead to a change in therapy or a reduction of dosages. This document is property of Regis College.
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References
American College of Cardiology. (n.d.). Project risk reduction by therapy
. ASCVD Risk Estimator +. https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/advice/riskgraph/ Goyal , A., Cusick, A., & Thielmier, B. (2023). ACE inhibitors - statpearls - NCBI bookshelf
. Ace Inhibitors. https://www.ncbi.nlm.nih.gov/books/NBK430896/ Khalil, H., & Zelser, R. (2023). Antihypertensive medications
. National Center for Biotechnology Information. https://pubmed.ncbi.nlm.nih.gov/32119466/ Onakpoya, I. (2020, June 1). Comparative effectiveness of combination treatment for hypertension in black Africans
. BMJ Evidence-Based Medicine. http://dx.doi.org/10.1136/bmjebm-2019-111251 This document is property of Regis College.