The Global Epidemiology of Hypertension Essay

The Global Epidemiology of Hypertension Essay

Introduction

A case study of R.S, a 65 years old African American male who presented with headache, nocturia, weight gain over the last year, and on examination, he has elevated blood pressure. In his past medical and surgical history, he reports having had an appendectomy done 30 years ago, has a history of type two diabetes mellitus for ten years, and peptic ulcer disease for 10 years. In his family, there is a positive history of chronic illnesses like hypertension, myocardial infarction, diabetes mellitus, and stroke. He smokes tobacco and has 35 pack years. He takes vodka weekly and two cups of coffee daily. The Global Epidemiology of Hypertension Essay

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On examination, he looks obese. His vitals are blood pressure at 140/89 mmHg on the left calf and 132/82 mmHg on the left arm. The pulse rate was 84 beats per minute with a regular rhythm. There is mild narrowing of arteries and sharps discs on Fundoscopic examination. There are no exudates or hemorrhages. Laboratory finding shows elevated BUN at 24mg/dl, creatinine is normal at 1.5g/dl, blood glucose is elevated at 95mg/dl, potassium is normal at 4.0mEq/l, total cholesterol is elevated at 201 mg/dl, HDL is reduced to 30mg/dl, and LDL is elevated to 167mg/dl. Urinalysis shows proteinuria 1+. ECG and chest X-ray shows mild left hypertrophy of the left ventricle.

Specific Goals for Treating Hypertension and Cholesterol 

The aim of treating hypertension and cholesterol is to prevent the occurrence of coronary heart disease (Mills, et al, 2020). This is because the patient is at risk of having coronary heart disease due to, obesity (body mass index of 35.16kg/m2), diabetes mellitus type two, he has 35 pack-years of smoking and taking alcohol hypertension, deranged lipid profile, and left ventricular hypertrophy. The Global Epidemiology of Hypertension Essay

First-Line Pharmacotherapy

First-line pharmacotherapy is atorvastatin 20mg every night for the management of high cholesterol levels. For hypertension, the first-line pharmacotherapy is calcium channel blocker, for example, nifedipine 20mg twice daily or amlodipine 5/10mg once daily (Mills, et al, 2020). Thiazide-like diuretics is also a first-line pharmacotherapy for hypertensive patients above 65 years old. An example is hydrochlorothiazide 25/50mg once daily.

Parameters for the Success of the Therapy

(Flack, et al, 2020) therapy is determined to be successful if it is effective in lowering the cholesterol levels and blood pressure to the recommended goal, has optimum tolerability profile with reduced drug adverse effects, the response increases with higher doses of the drugs, the drug is convenient once daily or twice daily to maximize the compliance, and it should have a rapid onset of effect after administration.

Health Promotion Recommendations

Health promotion is defined as empowering individuals to choose a healthy behavior that reduces the chances of developing a chronic illness. It involves observing the modifiable risk factors. For example, lack of physical exercise, poor eating habits, and tobacco use (Flack, et al, 2020). In this case, the patient should stop smoking tobacco, engage in physical exercise to burn out the excess fat and lose weight, engage in healthy eating habits like eating food rich in fiber, and avoid fatty foods to lower the cholesterol levels.

Impact of Diabetes Mellitus in Treatment Selection

Diabetes mellitus and hypertension are risk factors for kidney injury (Mills, et al, 2020). The drug of choice in the treatment of hypertension is a kidney-friendly drug that can be an angiotensin-converting enzyme and angiotensin receptor blocker. Examples are losartan and enalapril.

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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 In this discussion forum: 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 the parameters for monitoring the success of the therapy. Discuss health promotion recommendations you would consider for R. S. Does the presence of Diabetes Mellitus impact your treatment selection?

References

Flack, J. M., & Adekola, B. (2020). Blood pressure and the new ACC/AHA hypertension guidelines. Trends in cardiovascular medicine, 30(3), 160-164.

Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews Nephrology, 1-15. The Global Epidemiology of Hypertension Essay