Posted: February 13th, 2024

PHARM 6521 Hypertension Case Study HM is a 77 year old African American male

Hypertension Case StudyHM is a 77 year old African American male who presents to your clinic to establish care as a new patient.He and his wife recently moved to the area to be closer to family. His complaints that he is seeing you fortoday include severe gouty arthritis pain in his left great toe, and increasing frequency of headaches overthe last few weeks.PMH:He believes that he has been treated for high blood pressure in the past, but is not a good historianregarding treatments. He also does not recall how long he has been off the medication.He does not smoke now, but has a 10-12 pack year history.Current Medications:No prescription medications are taken at this time.OTC medications include:Multivitamin – 1 QDCalcium + Vit D 600 mg/800 IU – 1 QDIbuprofen 200 mg – 4 tabs every 6-8 hrs prn painVitals:BP:158/88 R arm/sitting162/89 L arm/sittingHR:77Ht:73 inchesWt:254 lbsLabs:CMP:SodiumPotassiumGlucoseCalciumAlbuminASTALTCr139 mmol/L4.1 mmol/L101 mg/dL9.4 mg/dL4.1 g/dL26 U/L31 U/L1.62 mg/dLLipid Panel:CholesterolTGHDLLDL165 mg/dL228 mg/dL37 mg/dL82 mg/dLTSHUric Acid2.40 uIU/ml9.7 mg/dLAnswer the following questions using the information above.1. Which of the following is FALSE?a. Cardiovascular disease is the leading cause of death in the US and worldwideb. Hypertension prevalence increases as age increases over 65 yearsc. Hypertension is the most common chronic disorderd. Education has improved hypertension awareness by 99%2. Which of the following is the best classification of HM’s blood pressure at your clinic today?a. Normalb. Pre-hypertensivec. Stage Id. Stage II3. Which of the following modifiable risk factors is most likely contributing to HM’s hypertension?a. Ageb. Smokingc. Obesityd. Use of NSAIDs4. Which of the following are TRUE?a. There are significant differences in guideline statements for assessment of BPb. The 2014 JNC 8 did not comment on assessment of BPc. Practitioners should avoid checking BP immediately after the patient enters the officed. Orthostatic or standing BP should be checked at 1-3 minutes after standinge. All of the above5. For which of the following causes of secondary hypertension should HM undergo screening?a. Primary aldosteronismb. Pheochromocytomac. Renovascular hypertensiond. None of the above6. Which of the following statements is correct regarding the Hypertension in the Very Elderly Trial(HYVET)?a. Antihypertensive treatment reduced the primary outcome of strokeb. Antihypertensive treatment increased 5-year survival at the expense of increased serioushypotensive eventsc. Antihypertensive treatment reduced total mortality and risk of heart failured. Antihypertensive treatment should only be attempted for secondary stroke prophylaxis7. Which of the following statements best reflects the changes in HM’s BP target between JNC7 andJNC8?a. No change in BP targetb. BP target increased from < 140/90 mmHg to < 150/90 mmHgc. BP target increased from < 140/90 mmHg to < 150/80 mmHgd. BP target increased from < 140/90 mmHg to < 160/90 mmHg8. You discuss the goal BP with HM, but he is skeptical of a higher target. He even shows you anarticle that he got online stating that 115/75 mmHg is the optimal BP and the risk of CV diseaseincreases for every 20/10 mmHg increase thereafter. He wonders why you don’t treat to that BPgoal since it is “the best.” What information from the ACCORD-BP trial can you use to helpexplain your reasoning?a. There are no benefits to additional blood pressure lowering beyond < 140/90 mmHgb. There is not enough evidence that the benefits of targeting a blood pressure < 120/80mmHg justify the additional risks of therapyc. Blood pressure of 115/75 mmHg is optimal and the data supports this level of therapyd. Being aggressive with blood pressure lowering in the elderly not only decreases thechance of CV disease, but can also greatly reduce the risk of stroke9. In which of the following patient groups would thiazides be considered a first-lineantihypertensive pharmacotherapy option?a. A 72 year old Caucasian female with stage IV CKD and proteinuriab. A 85 year old African American female with primary aldosteronismc. A 66 year old African American male with diabetesd. A 73 year old Caucasian male with pre-hypertension10. You decided at HM’s initial visit since he was new to you, to defer therapy and RTC in 1 month,during which time he would try nonpharmacologic interventions. At that time you also drew labsto get a baseline. You instructed him to take his BP at home and bring the readings to his nextappt. Upon returning he has no acute complaints, but looking over his BP log you determine anaverage BP of 161/92 (based on 3 selected readings). You take his BP in office today and it is161/91 mmHg and his standing BP in the office 145/76 mmHg. What therapy would be the mostappropriate at this time?a. Lisinopril 40 mg dailyb. Furosemide 40 mg dailyc. Chlorthalidone 12.5 mg QDd. Verapamil 120 mg ER daily11. HM returns to clinic for his first f/u visit after starting BP treatment. He stated he didn’t like howthe medication made him feel, and he had another gout flare, so he stopped it 5 days ago. Despitestopping the medication, he reports that his urinary frequency continues to increase and he isfeeling thirsty throughout the day. Although he is fasting this morning, his in office glucosefinger stick is 157 mg/dL. Rapid urine screen also shows 1+ protein. Which of the followingoptions is the most appropriate for HM today?a. Lisinopril 20 mg QDb. HCTZ 50 mg QDc. Amlodipine 10 mg QDd. Lisinopril 40 mg QD12. HM returns for f/u 4 weeks later. At last visit you started him on Allopurinol 100 mg daily, whichhe is still taking and symptom free. You look at his home BP log at this visit and the readings arebetter, but his average is still elevated at 152/89 mmHg. Which of the following would be thebest agent to add for combination therapy?a. Carvedilol 12.5 mg BIDb. Losartan 25 mg QDc. Amlodipine 5 mg QDd. HCTZ 25 mg QD13. HM’s BP is now well controlled upon f/u after starting combination therapy, as his home logaverage is 138/87 mmHg, and his in office BP today was 138/86 mmHg. Now that you have hishypertension controlled, it is time to think about his cardiovascular risk. What is his current 10year risk of heart disease or stroke?a. 10%b. 25%c. 33%d. 45%14. Based on the score you calculated, what treatment would you recommend for HM?a. No treatment necessaryb. Initiate low intensity statinc. Initiate moderate intensity statind. Initiate high intensity statin15. You decide that it would be beneficial to start HM on a statin. Which statin would be the mostappropriate?a. Crestor 40 mg QDb. Atorvastatin 40 mg QDc. Simvastatin 80 mg QDd. Lovastatin 20 mg QD

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