A 61-year-old Black male with a history of hypertension presents to your clinic with complaints of headaches and blurred vision x 4 days. He denies any weakness, numbness, chest pain, shortness of breath, palpitations, or recent illicit drug use. He states he has complied with his medications (hydrochlorothiazide and metoprolol) and took his meds this […]
The patient is showing symptoms of uncontrolled hypertension. The symptoms he has been exhibiting for the past four days are consistent with hypertension, such as headaches and blurred vision (Arnett et al., 2019). the provider must assess this patient further and thoroughly. The provider should determine if the patient has symptoms and if any immediate interventions are necessary. If the patient has headaches and blurred vision in the office, he may require transfer to a hospital for further evaluation or may need some PRN clonidine in the office. Also, it is essential to point out if the patient exhibits any signs or symptoms of fluid overload. Is there any edema present? Etc.
In addition, the provider needs to obtain an accurate, current medication list to assess for any pertinent medical history. It is crucial to find out which dosages the patient is currently on. If the patient has a history of diabetes or heart issues, it will be essential to consider this when adding or discontinuing the medication. For instance, the patient is an African American male currently on a beta-blocker and a thiazide diuretic. Yet, the recommendations say this patient should be started on a thiazide calcium channel blocker or both (Arnett et al., 2019). A heart condition may warrant the metoprolol prescription, but this is unknown.
Lastly, I would like to know the patient’s kidney function. If the patient has recent labs on file, it is crucial to review as this could also affect our treatment plan.
Response To Discussion Post 1
I appreciate your identification of uncontrolled hypertension as a potential diagnosis for the patient. You identify that the symptoms that the patient has been experiencing for the last four days insinuate that he might be having uncontrolled hypertension. The condition results from inadequate or no treatment of blood pressure during its early stages, which results in rapid disease progression and increased risk of hypertension-induced cardiovascular diseases (Victor et al., 2019). Symptoms of uncontrolled hypertension include blurred vision, lightheadedness, severe headache, and chest discomfort (Pierdomenico et al., 2018, p. 862). Since the patient presents to the clinic with complaints about headaches and blurred vision that has lasted four days, he might have contracted uncontrolled hypertension. You also identify amlodipine as an appropriate medication to help alleviate severe symptoms. The medication helps to regulate blood pressure and minimize adverse implications such as strokes and heart attacks. Therefore, I acknowledge the effectiveness of the treatment plan that you recommend for the patient.
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., Michos, E. D., Miedema, M. D., Muñoz, D., Smith, S. C., Virani, S. S., Williams, K. A., Yeboah, J., & Ziaeian, B. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: Executive summary: A report of the American college of cardiology/American heart association task force on clinical practice guidelines. Circulation, 140(11). https://doi.org/10.1161/cir.0000000000000677
Nayef, S., Ogedegbe, G., Ravenell, J., Seyedali, S., & Williams, S. (2016). Hypertension Treatment in Blacks: Discussion of the U.S. Clinical Practice Guidelines. Progress in Cardiovascular Diseases.
Pierdomenico, S. D., Pierdomenico, A. M., Coccina, F., Clement, D. L., De Buyzere, M. L., De Bacquer, D. A., Ben-Dov, I., Vongpatanasin, W., Banegas, J., Ruilope, L., Thijs, L., & Staessen, J. A. (2018). Prognostic value of masked uncontrolled hypertension: systematic review and meta-analysis. Hypertension, 72(4), 862-869.
Townsend, R. (2020, April 13). Definition, Risk Factors, and Evaluation of Resistant Hypertension. Retrieved from UpToDate: https://www.uptodate.com/contents/definition-risk-factors-and-evaluation-of-resistant-hypertension
Victor, R. G., Li, N., Blyler, C. A., Mason, O. N. R., Chang, L. C., Moy, N. P. B., Rashid, M., Weiss, J., Hadler, J., Brettler, J., Sagisi, M., Rader, F., & Elashoff, R. M. (2019). Nocturia as an unrecognized symptom of uncontrolled hypertension in black men aged 35 to 49 years. Journal of the American Heart Association, 8(5), e010794. https://www.ahajournals.org/doi/full/10.1161/JAHA.118.010794
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Published On: 01-01-1970