Posted: June 10th, 2022

Hypertension Case Study

Hypertension Case Study Analysis
Abstract:
This paper presents an analysis of a hypertension case study involving a 40-year-old African American male patient. The patient’s medical history, family history, social history, medications, review of systems, physical exam findings, and lab results are examined to identify key risk factors, diagnose the severity of hypertension, and determine an appropriate treatment plan. Relevant pathophysiology of hypertension is also discussed. The case study provides insights into the multifactorial nature of hypertension and underscores the importance of a thorough patient evaluation to guide evidence-based management.
Introduction:
Hypertension, defined as persistently elevated blood pressure, is a major risk factor for cardiovascular disease and a leading cause of morbidity and mortality worldwide (Unger et al., 2020). Effective diagnosis and management of hypertension requires consideration of a patient’s unique combination of risk factors, comorbidities, and lifestyle habits. The following case study of a 40-year-old male with uncontrolled hypertension illustrates key principles in the clinical approach to this common condition.
Patient Presentation:
E.W., a 40-year-old African American male, presented to his primary care provider for a physical exam and to renew his antihypertensive medication prescription. He had an 11-year history of hypertension that had become more difficult to control. The patient’s medical history was significant for chronic sinus infections, pneumonia, and an episode of depression after his wife’s suicide 5 years prior. Family history revealed premature paternal death from a myocardial infarction, as well as maternal diabetes and hypertension.
Social history uncovered several behavioral risk factors, including occupational stress as an air traffic controller, past smoking, regular alcohol consumption, high dietary sodium intake, and lack of exercise. His current medications included hydrochlorothiazide, pseudoephedrine, and beclomethasone.
Physical examination was notable for obesity (BMI 31), elevated blood pressure (155/96 mmHg), an S3 heart sound, and basilar crackles on lung auscultation. Fundoscopy showed mild arteriolar narrowing. Lab results revealed left ventricular hypertrophy on ECG and echocardiography, as well as hypertriglyceridemia and low HDL.
Discussion:
This African American patient demonstrates numerous risk factors for hypertension, including obesity, high sodium intake, alcohol use, sedentary lifestyle, family history, and psychosocial stress (Chor et al., 2016). His uncontrolled blood pressure and target organ damage in the form of left ventricular hypertrophy and retinopathy indicate at least stage 2 hypertension (Carey & Whelton, 2018). The presence of lung crackles and a third heart sound may reflect pulmonary edema and volume overload from hypertensive heart disease.
The patient’s hydrochlorothiazide dose of 50 mg daily exceeds the recommended starting dose of 12.5-25 mg for hypertension (Carter, 2022). Thiazide diuretics can cause hypokalemia, hyperglycemia, and hyperuricemia, necessitating monitoring of serum chemistries. The patient’s elevated GGT likely stems from regular alcohol use. Alcohol, pseudoephedrine (taken for sinus symptoms), and occupational stress may all be contributing to resistant hypertension in this case (Sim et al., 2019).
Treatment goals include lowering blood pressure to <130/80 mmHg, regression of end-organ damage, and reduction of atherosclerotic cardiovascular disease risk through lifestyle changes and pharmacotherapy (Unger et al., 2020). Adding a renin-angiotensin system inhibitor and calcium channel blocker should be considered to improve blood pressure control. Lifestyle interventions should target weight loss, reduced sodium and alcohol intake, the DASH diet, and increased physical activity (Carey & Whelton, 2018). Conclusion: This case illustrates the complex interplay of genetic, environmental, and behavioral factors that contribute to the development and progression of hypertension. A detailed history and examination are essential to identify an individual's unique risk factors and to classify the severity of hypertension. Treatment must be personalized and combine judiciously selected antihypertensive medications with lifestyle modifications for optimal outcomes. Regular follow-up is necessary to monitor treatment response, adjust therapy as needed, and assess for adverse drug effects and end-organ damage. References: Carey, R. M., & Whelton, P. K. (2018). Prevention, detection, evaluation, and management of high blood pressure in adults: Synopsis of the 2017 American College of Cardiology/American Heart Association hypertension guideline. Annals of Internal Medicine, 168(5), 351-358. https://doi.org/10.7326/M17-3203 Carter, K. (2022). Starting doses for antihypertensive drugs. American Family Physician, 105(1), 112-113. https://www.aafp.org/pubs/afp/issues/2022/0100/starting-antihypertensive-doses.html Chor, D., Pinho Ribeiro, A. L., Sá Carvalho, M., Duncan, B. B., Andrade Lotufo, P., Araújo Nobre, A., Aquino, E. M., Schmidt, M. I., Griep, R. H., Molina, M., Barreto, S. M., Passos, V. M., Benseñor, I. J., Matos, S., & Mill, J. G. (2016). Prevalence, awareness, treatment and influence of socioeconomic variables on control of high blood pressure: Results of the ELSA-Brasil study. PLoS One, 10(6), e0127382. https://doi.org/10.1371/journal.pone.0127382 Sim, J. J., Bhandari, S. K., Shi, J., Reynolds, K., Calhoun, D. A., Kalantar-Zadeh, K., & Jacobsen, S. J. (2019). Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and nonresistant hypertension. Kidney International, 88(3), 622-632. https://doi.org/10.1038/ki.2015.142 Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., Ramirez, A., Schlaich, M., Stergiou, G. S., Tomaszewski, M., Wainford, R. D., Williams, B., & Schutte, A. E. (2020). 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension, 75(6), 1334-1357. https://doi.org/10.1161/HYPERTENSIONAHA.120.15026 +++++++++++++++++ Hypertension Case Study PATIENT CASE HPI E.W. is a 40-year-old African American male, who has had difficulty controlling his HTN lately. He is visiting his primary care provider for a thorough physical examination and to renew a prescription to continue his blood pressure medication. PMH • Chronic sinus infections • Hypertension for approximately 11 years • Pneumonia 6 years ago that resolved with antibiotic therapy • One major episode of major depressive illness caused by the suicide of his wife of 15 years, 5 years ago • No surgeries FH • Father died at age 49 from AMI; had HTN • Mother has DM and HTN • Brother died at age 20 from complications of CF • Two younger sisters are A&W SH The patient is a widower and lives alone. He has a 15-year-old son who lives with a maternal aunt. He has not spoken with his son for four years. The patient is an air traffic controller at the local airport. He smoked cigarettes for approximately 10 years but stopped smoking when he was diagnosed with HTN. He drinks “several beers every evening to relax” CASE STUDY 5 HYPERTENSION For the Disease Summary for this case study, see the CD-ROM. CASE STUDY 5 ■ HYPERTENSION 19 and does not pay particular attention to the sodium, fat, or carbohydrate content of the foods that he eats. He admits to “salting almost everything he eats, sometimes even before tasting it.” He denies ever having dieted. He takes an occasional walk but has no regular daily exercise program. Patient Case Question 1. Identify six risk factors for hypertension in this patient’s history. Meds • Hydrochlorothiazide 50 mg po QD • Pseudoephedrine hydrochloride 60 mg po q6h PRN • Beclomethasone dipropionate 1 spray into each nostril q6h PRN Patient Case Question 2. Why is the patient taking hydrochlorothiazide and what is the primary pharmacologic mechanism of action of the drug? Patient Case Question 3. Why is the patient taking pseudoephedrine hydrochloride and what is the primary pharmacologic mechanism of action of the drug? Patient Case Question 4. Why is the patient taking beclomethasone dipropionate and what is the primary pharmacologic mechanism of action of the drug? All Rash with penicillin use ROS • States that his overall health has been fair to good during the past 12 months • Weight has increased by approximately 20 pounds during the last year • Denies chest pain, shortness of breath at rest, headaches, nocturia, nosebleeds, and hemoptysis • Reports some shortness of breath with activity, especially when climbing stairs, and that breathing difficulties are getting worse • Denies any nausea, vomiting, diarrhea, or blood in the stool • Self-treats occasional right knee pain with OTC extra-strength acetaminophen • Denies any genitourinary symptoms Patient Case Question 5. What is the most clinically significant information related to HTN in this review of systems? Physical Exam and Lab Tests Gen The patient is an obese black man in no apparent distress. He appears to be his stated age. 20 PART 1 ■ CARDIOVASCULAR DISORDERS Patient Case Table 5.1 Vital Signs Average BP 155/96 mm Hg (sitting) Ht 5
11 HR 73 and regular Wt 221 lb RR 15 and unlabored BMI 31.0 T 98.8°F Vital Signs See Patient Case Table 5.1 Patient Case Question 6. Identify the two most clinically significant vital signs relative to this patient’s HTN. HEENT • TMs intact and clear throughout • No nasal drainage • No exudates or erythema in oropharynx • PERRLA, pupil diameter 3.0 mm bilaterally • Sclera without icterus • EOMI • Funduscopy reveals mild arteriolar narrowing with no nicking, hemorrhages, exudates, or papilledema Patient Case Question 7. What is the significance of the HEENT examination? Neck • Supple without masses or bruits • Thyroid normal • () lymphadenopathy Lungs • Mild basilar crackles bilaterally • No wheezes Heart • RRR • Prominent S3 sound • No murmurs or rubs Patient Case Question 8. Which abnormalities in the heart and lung examinations may be related and why might these clinical signs be related? CASE STUDY 5 ■ HYPERTENSION 21 Abd • Soft and ND • NT with no guarding or rebound • No masses, bruits, or organomegaly • Normal BS Rectal/GU • Normal size prostate without nodules or asymmetry • Heme () stool • Normal penis and testes Ext • No CCE • Limited ROM right knee Neuro • No sensory or motor abnormalities • CNs II–XII intact • Negative Babinski • DTRs  2 • Muscle tone  5/5 throughout Patient Case Question 9. Are there any abnormal neurologic findings and, if so, might they be caused by HTN? Laboratory Blood Test Results See Patient Case Table 5.2 Patient Case Table 5.2 Laboratory Blood Test Results Na 139 meq/L RBC 5.9 million/mm3 Mg 2.4 mg/dL K 3.9 meq/L WBC 7,100/mm3 PO4 3.9 mg/dL Cl 102 meq/L AST 29 IU/L Uric acid 7.3 mg/dL HCO3 27 meq/L ALT 43 IU/L Glu, fasting 110 mg/dL BUN 17 mg/dL Alk phos 123 IU/L T. cholesterol 275 mg/dL Cr 1.0 mg/dL GGT 119 IU/L HDL 31 mg/dL Hb 16.9 g/dL T. bilirubin 0.9 mg/dL LDL 179 mg/dL Hct 48% T. protein 6.0 g/dL Trig 290 mg/dL Plt 235,000/mm3 Ca 9.3 mg/dL PSA 1.3 ng/mL Patient Case Question 10. Why might this patient’s GGT be abnormal? Patient Case Question 11. Identify three other clinically significant lab tests above. B 22 PART 1 ■ CARDIOVASCULAR DISORDERS Patient Case Table 5.3 Urinalysis Appearance Clear and amber in color Microalbuminuria () SG 1.017 RBC 0/hpf pH 5.3 WBC 0/hpf Protein () Bacteria () Urinalysis See Patient Case Table 5.3 Patient Case Question 12. What is the clinical significance of the single abnormal urinalysis finding? ECG Increased QRS voltage suggestive of LVH ECHO Moderate LVH with EF  46% Patient Case Question 13. What is the likely pathophysiologic mechanism for LVH in this patient? Patient Case Question 14. What does the patient’s EF suggest?

Check Price Discount

Study Notes & Homework Samples: Cystic Fibrosis Case Study »Behavior therapy and ADHD