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
"I need to get my meds renewed."
History of Present Illness
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.
Seasonal allergic rhinitis since childhood
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.
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.
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.
Allergies/Intolerances/Adverse Drug Events
Loratadine 10 mg PRN (Was taking allopurinol 200 mg and simvastatin 40 mg daily prior to losing insurance coverage.)
Constipation despite fiber-rich diet and at least 64 oz. (1.9 L) water daily. Otherwise unremarkable.
Well-appearing, middle-aged, Hispanic male in no acute distress.
BP 146/94 mm Hg, repeat 144/92 mm Hg (right arm, regular cuff), P 56 bpm, RR 12, T 36°C.
Weight 168.4 lb (76.5 kg)