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“Nothing they did helped my blood pressure.”
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History of Present Illness
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Ghalen Jones is a 56-year-old African-American male who presents to your clinic as a new patient stating, “Nothing they did helped my blood pressure. I hope you can do better.” He also complains of headaches, chronic lower back pain, and general weakness. He takes over-the-counter ibuprofen which alleviates the back pain but provides little help for the headache. Mr. Jones has a long history of hypertension (HTN), first diagnosed in his mid-40s. Over the years, he has had difficulty adhering to the suggested pharmacological treatments, and his blood pressure has been poorly controlled. His blood pressure, noted in the medical chart, was as high as 210/134 in the past, and he has a history of epistaxis, headache, and occasional palpitations. He went to the emergency room due to hypertensive urgency about a year ago. Mr. Jones reports that he has been taking many blood pressure medications, but he admits to taking medications irregularly because the medications interfere with his sexual function and make him tired all the time. As a result, he forgets to renew prescriptions at times. He knows he does not eat right but he does not know how to cook and with no interest in learning how to cook. He usually eats at fast-food restaurants as the food is cheap and quick. He says, “if you can get my blood pressure under control, I can start exercising and lose some weight.” He brings in all his pill bottles, including an over-the-counter supplement he is considering taking to “jump-start some weight loss.” He has a significant family history, with his father dying at age 55 from hypertension-related cardiovascular disease (CVD), and both his maternal and paternal grandparents had CVD.
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What stage hypertension does this patient have, and what is his target blood pressure?
Hint: See Table 6-1, Table 6-2 in PPP
Does this patient have resistant hypertension, and what are some contributing factors in uncontrolled hypertension?
Hint: See the Etiology Section in Chapter 6 and Table 6-4 in PPP
How can this patient participate in his blood pressure management and improve control?
Hint: See the Treatment Section in Chapter 6, Table 6-6 in PPP
Based on this patient’s individual characteristics, what are the advantages and disadvantages of different therapeutic options for the treatment of hypertension?
Hint: See Table 6-7 in PPP
What and how will you educate the patient about potential risks and adverse effects of therapy and follow-up monitoring parameters?
Hint: See the Outcome Evaluation Section in Chapter 6 and Table 6-7...