R. S., a 65-year-old African-American man, was referred to the CNP in the hypertension clinic for evaluation of high BP noted on an initial screening. He reports having headaches and nocturia. He states that he has gained 8 pounds over the last year. Past medical history: Appendectomy 30 years ago, Peptic ulcer disease 10 years ago, Type 2 diabetes mellitus for 10 years; Family history: Father had hypertension; died of myocardial infarction at age 55, Mother had diabetes mellitus and hypertension; died of cerebrovascular accident at age 60; Physical examination: Height 69 in, weight 108 kg; BP: 140/89 mm Hg (left arm), 138/82 mm Hg (right arm); Pulse: 84 beats/min, regular; Funduscopic examination: mild arterial narrowing, sharp discs, no exudates or hemorrhages; Laboratory findings: Blood urea nitrogen: 24 mg/dL, Serum creatinine: 1.5 mg/dL, Glucose: 95 mg/dL, Potassium: 4.0 mEq/L, Total cholesterol: 201 mg/dL, High-density lipoprotein cholesterol: 30 mg/dL, Triglycerides: 167 mg/dL, Urinalysis: 1+ proteinuria; Electrocardiogram and chest radiograph: mild left ventricular hypertrophy; Social history: Tobacco: 35 pack years, Alcohol: pint of vodka/week, Coffee: 2 cups/day
Diagnosis: Stage 1 Hypertension
Discuss specific goals for pharmacotherapy for treating R. S.’s hypertension and cholesterol.
Discuss what you would consider to be first-line pharmacotherapy for R. S., and why.
Discuss health promotion recommendations you would consider for R. S. and how you would monitor the progress.
Does the presence of Diabetes Mellitus impact your treatment selection?
