Case Study 1

CFis a sixty-year-old African American male who presents as a new patientfor initial evaluation and follow-up. He has been diagnosed withhypertension for the last twelve years and Type 2 diabetes for the sameperiod of time. His current blood pressure is 162/90, with a pulse of76. His body mass index (BMI) is 32. He is currently taking Maxzide37.5/25 mg every morning. This is the only antihypertensive medicationhe has taken.

Forthis question, focus on the treatment of hypertension. Discuss theinfluences of his age, gender, and ethnicity on hypertensivemedications. On the basis of an analysis of those factors, provide oneoption for improvement of his blood pressure and provide a clear andspecific justification for that choice. Be sure to include dosage andscheduling. Include highlights of patient teaching and/orrecommendations for any lifestyle changes. Support your decisions withat least one reference to a published clinical guideline and onepeer-reviewed publication.

ANSWER

Highblood pressure is a life-threatening condition where the blood’slong-term force on the walls of your artery is powerful enough to causesome heart disease (Go et al., 2014). It depends on the amount of theblood pumped by your heart and the resistance this blood encounters inyour arteries. The narrower the arteries are, the higher the bloodpressure. High blood pressure develops over the years. Fortunately, itis detectable and controllable. High blood pressure that is uncontrolledfor a long time causes serious health problems such as heart attack,kidney failure, heart failure and stroke. However, hypertensivemedication is influenced by the patient’s age, his or her gender, andethnicity. Lifestyle changes boost the control and treatment of highblood pressure (Woo & Wynne, 2012).

Theideal blood pressure for people aged 60 years and above is 150/90. CF’sblood pressure is 162/90 which means it is high despite his dailyintake of Maxzide 37.5/25. The ideal body mass (IBM) for an adult isbetween 18 and 24. CF is 32 meaning he is obese.Studies reveal that highblood pressure affects men more than women (Go et al., 2014). After theage of 55 years, women tend to suffer from blood pressure more thanmen.However, more male suffers from complications related to bloodpressure more than females (Liao, at el., 2016). Most males with highblood pressure suffer from heart attack, heart failure, and other heartdiseases if not controlled. Studies show that fewer people aged 39 yearsand below suffer from high blood pressure as compared to above 40. Itis therefore correct to conclude that age influences the presence ofhigh blood pressure. Several types of research have revealed that if onecomes from a family history that has had blood pressure, there is alikelihood that they too are at an elevated risk of having high bloodpressure at one time in their life. It is therefore evident thatethnicity has an influence in the presence or absence of blood pressure.

Mostpeople with the diabetic condition, renal impairment, elderly orseverely ill suffer from hyperkalemia, that is, high potassium in theblood. Maxzide should not be administered to patients with hyperkalemiaand should discontinue immediately. There’s a likelihood that CF couldbe suffering from hyperkalemia following the fact that he is diabeticand elderly. That could be the reason why his blood pressure is stillhigh despite taking the treatment. I recommend Calcium channel blockers.They are drugs that lower blood pressure by slowing calcium movement inthe heart’s cells and in the walls of the blood vessels. It enables theheart to pump the blood and widen its vessels. With enlarged bloodvessels, the heart needs not overwork hence the blood pressure islowered (Liao et al., 2016). Norvasc (Amlodipine) is one of the bestCalcium channel blockers used to treat high blood pressure. It is takenorally with or without food only once daily. Most people prefer takingit with water or milk. I would recommend that CF takes it with some milkof food. Dosage may be increased or decrease it depending on CF’sreaction. Calcium channel blocker is ideal for the black and elderlypatients such as CF. He should avoid grape juice of fruit as itinterferes with the drugs reaction on the body. I would ask CF to ensurethat he eats a balanced diet and, a lot of fruits and vegetables. Heshould also ensure that he does lighter exercises like walking 30minutes daily. He should also reduce his sodium intake, red meat, andcholesterol.

References

Go,A. S., Bauman, M. A., Coleman King, S. M., Fonarow, G. C., Lawrence,W., Williams, K. A., & Sanchez, E. (2014). An effective approach tohigh blood pressure control. Journal of the American College of Cardiology, 63(12), 1230-1238. doi:10.1016/j.jacc.2013.11.007

Liao,Y., Siegel, P. Z., White, S., Dulin, R., & Taylor, A. (2016).Improving actions to control high blood pressure in Hispaniccommunities—Racial and Ethnic Approaches to Community Health Across theUS Project, 2009–2012. Preventive medicine, 83, 11-15.

Woo, T. & Wynne, A. (2012). Pharmacotherapeutics for Nurse Practitioner Prescribers. Philadelphia, PA: F.A. Davis Company