[Solved] 61-year-old Black male Hypertension Case Study 1

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.

Differentials

1. Uncontrolled HTN as evidenced by c/o of headaches and blurred vision x 4 days. Townsend, R. (2020, April 13)
2. High cholesterol levels and low HDLs evidence dyslipidemia. In addition, the patient has a 32% ASCVD risk based on his medical history and age. (Nayef et al., 2016)

Plan

• Atorvastatin 20mg PO QHS – this is a moderate statin recommended for the ASCVD risk of this patient of 32% (Nayef et al., 2016)
• Continue metoprolol – Since the patient’s dosage and further medical history are unknown, I will most likely have to continue the medication at this time until additional information is obtained (Nayef et al., 2016).
• Start Amlodipine 2.5mg po QD. Calcium channel blockers are recommended for the treatment of hypertension in African Americans. Depending on the dosage o the channel blocker, the patient will need to take it in conjunction with the beta-blocker or alone with a diuretic (Arnett et al., 2019).
• If the patient does not have recent labs, I would order CBC, CMP, TSH, and A1C. (Arnett et al., 2019)

Education

• BP log
• Lifestyle modifications.

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.

References

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