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Number 1 post: JZ
For our Week 3 discussion, I have reviewed a case of a 57-year-old African American female who is obese and presents to the clinic with high blood pressure (146/92). She exhibited high blood pressure recently at a health fair (168/99), then on several occasions soon after (145/90, 150/89, 140/88). She has a family history of hypertension and diabetes, so she is also at risk of such conditions. She had a previous episode of high blood pressure (135/95) five years ago, in which lifestyle modifications were recommended. Unfortunately, she was non-compliant in following recommendations for diet and keeping a daily blood pressure (BP) log at home. Her LDL and triglycerides were elevated then, but she failed to repeat labs. She presents today with a similar presentation. She has high blood pressure (146/92), BMI 36.6 (obese), and an elevated lipid profile (LDL 138, HDL 48, Triglycerides 170).
The first line of treatment recommended by the JNC8 would be for patients less than 60 years old to initiate a thiazide diuretic or calcium channel blocker (CCB) (Philippine Academy of Family Physicians [PAFP], n.d.). With her family history, being obese, and being an African American – having high-risk factors for diabetes, I probably would wait to begin a thiazide until ordering glucose or a1c if appropriate. The use of thiazides as antihypertensive agents can be associated with metabolic adverse events, including hyperglycemia – although it can decrease cardiovascular events, it may still be used in small doses in patients with hypertension and diabetes (Scheen, 2018). It is very patient-specific, and further assessment would be needed. As for the American Heart Association (AHA) / American College of Cardiology (ACC) guidelines, they focus on earlier diagnosis of hypertension. If blood pressure is >130/80, drug therapy is not recommended until >140/90 with risk factors for stroke prevention. With her high lipid profile, obesity, the risk for heart disease and diabetes, and her current BP 146/92, drug therapy may be more appropriate. Five years ago, diet, exercise, and weight loss may have been recommended with her past BP 135/95, but more is needed now. The ACC/AHA hypertension treatment guidelines are comprehensive, covering all aspects including diagnosis, evaluation, and monitoring, secondary causes, as well as drug and non-drug treatments. (Flack & Adekola, 2020).
My recommended medication to start this patient would be a drug called Amlodipine. Amlodipine is an antihypertensive drug that is in the calcium channel blocker drug class, which is also known as the generic amlodipine besylate or Norvasc trade name, with the initial starting dose for adults being 5 mg po daily (Lippincott Williams & Wilkins, 2021). This medication blocks the calcium from entering the cardiac muscle and dilates or widens the coronary arteries. This, therefore, decreases blood pressure and the oxygen demand on the heart (Lippincott Williams & Wilkins, 2021). As
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