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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Classify blood pressure levels

  • Identify the goals of therapy for HTN

  • Select appropriate HTN therapy based on patient's individual characteristics

  • Develop an appropriate monitoring and follow-up plan

  • Properly educate a patient about antihypertensive treatment

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PATIENT PRESENTATION

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Chief Complaint

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"I need to get my meds renewed."

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History of Present Illness

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Jose Vasquez is a 57-year-old Mexican American male who lost his job 6 months ago, and had not refilled any of his prescription medications for approximately 5 months because of cost (lost his insurance coverage). He has now started a new job and again has prescription drug coverage. He is concerned because his 52-year-old brother had a heart attack 2 years ago. Jose states his cholesterol was "where it was supposed to be" according to his previous physician while he was on simvastatin 40 mg in the past. Jose also mentions that his blood pressure has been in the 140s/90s at his gym, and he wonders if that is okay. He reports eating a low-fat diet, and exercises (walking, weightlifting) approximately 30 minutes three times/week.

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Past Medical History

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Dyslipidemia 2006

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Gout 2010

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Seasonal allergic rhinitis since childhood

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Family History

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Father died from MVA at the age of 35. Mother's age is 77 with HTN, osteoporosis, and a history of breast cancer. He has a brother (5 years younger) with dyslipidemia, HTN, type 2 DM; MI at age 50. He has two younger sisters, one has HTN, and both have dyslipidemia.

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Social History

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Born in the United States after his parents emigrated from Mexico. Married and lives with his wife; has three sons aged 35, 32, and 26 (all healthy). Recently started working at the U.S. Post Office.

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Tobacco/Alcohol/Substance Use

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Two to four drinks/week; tobacco use 1 ppd (41 pack-year history), "knows he should quit" but is unwilling to set a quit date given the stress of his new job; (−) illicit drug use.

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Allergies/Intolerances/Adverse Drug Events

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NKDA

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Medications (Current)

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Loratadine 10 mg PRN (Was taking allopurinol 200 mg and simvastatin 40 mg daily prior to losing insurance coverage.)

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Review of Systems

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Constipation despite fiber-rich diet and at least 64 oz. (1.9 L) water daily. Otherwise unremarkable.

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Physical Examination

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General
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Well-appearing, middle-aged, Hispanic male in no acute distress.

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Vital Signs
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BP 146/94 mm Hg, repeat 144/92 mm Hg (right arm, regular cuff), P 56 bpm, RR 12, T 36°C.

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Weight 168.4 lb (76.5 kg)

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