The given case study presents a sixty-year-old African American male patient who has been diagnosed with hypertension and types 2 diabetes for the last twelve years. His body index is 32, and he is currently taking no other medication except 37.5/25 mg every morning.
The information about the patient’s age, ethnicity, and gender allow forming a holistic picture of his condition. As far as age is concerned, people over 55 are highly prone to suffering from heart conditions, which is especially applicable to men (Bhatt et al., 2014). Moreover, African-Americans often have problems with blood pressure even in younger years. Their wide-spread insulin resistance and high obesity rates that lead to the development of type 2 diabetes aggravate the problem (Sowers, 2013). Besides, it has also been found out by researchers that African-Americans have a gene that accounts for their salt sensitivity. As a result, the consumption of each extra gram of salt is capable of raising their blood pressure as much as 5 mm Hg (Trief et al., 2013).
Obesity deserves to be treated as an independent risk factor that contributes to the development of cardiovascular diseases including hypertension. The most hazardous factor in the given case is the combination of Type 2 diabetes (aggravated by obesity) with hypertension. This predisposes the patient to heart failure and may lead to cardiac death unless addressed in due time (Alpert, Lavie, Agrawal, Aggarwal, & Kumar, 2014).
Maxzide that the patient is currently taking presents a great risk to his health as it is capable of increasing potassium levels in elderly patients who suffer from diabetes. High potassium levels must be closely monitored since they can be fatal if ignored (Salahuddin, Mushtaq, & Materson, 2013). Therefore, the administration of the drug should be discontinued.
The suggested option for improving the condition of the patient is the application of ACEIs (angiotensin-converting enzyme inhibitors) that can effectively reduce blood pressure in obese patients being metabolically neutral. ACEIs are more effective than calcium channel blockers and diuretics as they improve glucose tolerance, stabilize insulin levels, and can be administered to patients suffering from Type 2 diabetes mellitus, which is perfectly suitable to the given case. Benazepril can be a good option to replace Maxzide. The dosage starts from 5 mg/day and can be increased to 20-40 mg/day taken in a single dose or two divided doses (the necessity for divided dosing should be identified through the analysis of the response). The drug may be used for monotherapy or in combination with other medications (Hao et al., 2014).
Certain lifestyle interventions are required as a part of treatment along with pharmacotherapy. The patient’s diet must be adjusted for sugar and salt content. For type 2 diabetes mellitus, carbohydrates should comprise 50-65% of the total calorie intake (which is identified according to weight reduction goals), proteins should not exceed 20-30% whereas only less than 7% of fats are allowed (out of the total 30% of all fats). For diabetic patients suffering from hypertension, the most suitable diet should be low-fat or low-carbohydrate and contain an app. 1000 fewer calories than the nutrition for weight maintenance. The effect is expected to be evident in rather a short term (6-12 months) (Li et al., 2014).
Healthy nutrition must be combined with regular moderate physical activity to help the patient lose weight, which could reduce the pill burden in managing blood pressure. Another option is bariatric surgery, which can be much more effective than medications (Li et al., 2014).
References
Alpert, M. A., Lavie, C. J., Agrawal, H., Aggarwal, K. B., & Kumar, S. A. (2014). Obesity and heart failure: Epidemiology, pathophysiology, clinical manifestations, and management. Translational Research, 164(4), 345-356.
Bhatt, D. L., Kandzari, D. E., O’neill, W. W., D’agostino, R., Flack, J. M., Katzen, B. T.,… Cohen, S. A. (2014). A controlled trial of renal denervation for resistant hypertension. New England Journal of Medicine, 370(15), 1393-1401.
Hao, G., Wang, Z., Guo, R., Chen, Z., Wang, X., Zhang, L., & Li, W. (2014). Effects of ACEI/ARB in hypertensive patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled studies. BMC Cardiovascular Disorders, 14(1), 148-165.
Li, G., Zhang, P., Wang, J., An, Y., Gong, Q., Gregg, E. W.,… Engelgau, M. M. (2014). Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: A 23-year follow-up study. The Lancet Diabetes & Endocrinology, 2(6), 474-480.
Salahuddin, A., Mushtaq, M., & Materson, B. J. (2013). Combination therapy for hypertension 2013: An update. Journal of the American Society of Hypertension, 7(5), 401-407.
Sowers, J. R. (2013). Diabetes mellitus and vascular disease. Hypertension, 61(5), 943-947.
Trief, P. M., Izquierdo, R., Eimicke, J. P., Teresi, J. A., Goland, R., Palmas, W.,… Weinstock, R. S. (2013). Adherence to diabetes self care for white, African-American and Hispanic American telemedicine participants: 5 year results from the IDEATel project. Ethnicity & Health, 18(1), 83-96.