Introduction
Based on the subjective and objective data presented in the case, it is possible to assume C.D. has hypertension (HT). It is one of the most widespread chronic disorders among adults: it affects nearly 1 billion people around the globe (Wise & Charchar, 2016). HT decreases the quality of life while increasing the risk for the development of cardiovascular disorders, leading to disability, and reducing life expectancy.
Diagnostics
According to Rubenfire (2017), “prior to labeling a person with hypertension, it is important to use an average based on ≥2 readings obtained on ≥2 occasions to estimate the individual’s level of BP” (para. 2). However, since the patient’s indicators are significantly above the normal range, and he showed the symptoms of HT for an extended period, the diagnosis can be made right away. Still, a healthcare practitioner can instruct the patient to perform a blood pressure reading at home and use the data for the confirmation of the diagnosis.
According to HT diagnosis and assessment guidelines, if during the first visit, a patient’s SBP is ≥180 mmHg, and DBP is ≥110 mmHg, it is essential to perform the physical examination and appropriate diagnostic tests in order to identify possible target organ damage including cerebrovascular disease, hypertensive retinopathy, renal disease, heart failure, etc. (Gelfer et al., 2015). For instance, blood tests can be administered to measure the patient’s cholesterol levels and red blood cell content; electrocardiogram − to identify abnormalities in the heart’s electrical activity, urinalysis − to measure the level of protein and bacteria in the urine, etc.
Management Plan
Pharmacological treatment measures may include various groups of drugs: diuretics, ACE inhibitors, calcium channel blockers, beta-blockers (Braunwald & Hollenberg, 2013). Since the patient is associated with a high risk of complications (based on the family history of HTN, as well as some exogenous factors), it would be appropriate to prescribe a few types of drugs for him because the intake of medicines with different active mechanisms allows reducing blood pressure and mitigating possible adverse side effects. For instance, the combination of indapamide with angiotensin II receptor blocker increases the effectiveness of treatment and helps to prevent the increase in serum uric acid (Okamura, Shirai, Totake, Okuda, & Urata, 2017).
Lifestyle changes are of significant importance in the treatment of HT. The nutritional intervention may be based on the Dietary Approaches to Stop Hypertension (DASH) framework, which suggests “a diet rich in fruits, vegetables, and low-fat dairy products and reduced saturated and total fat” (Bazzano, Green, Harrison, & Reynolds, 2013, p. 695). Along with this, the intake of salt should be significantly reduced (to <1,500 mg/day) as the patient falls under the category of people predisposed towards sodium sensitivity: “African Americans, middle- and older-aged persons, and individuals with hypertension, diabetes, or chronic kidney disease” (Bazzano et al., 2013, p. 700). Moreover, avoidance of smoking and alcohol intake can help significantly alleviate the symptoms of HT.
Patient Education
In order to facilitate the maintenance of healthcare needs, various barriers to health promotion should be identified and addressed. For instance, the effects of negative beliefs and fear regarding the consequences of drug intake can be mitigated by emphasizing the importance of medication adherence. Considering that the majority of African Americans view HT as an inevitable condition linked to aging, it is appropriate to provide empirical evidence showing the patient that diet modification and exercising can significantly reduce the risk of mortality (Khatib et al., 2014).
Along with the information on the benefits and importance of healthier lifestyle, the patient should be provided with the data on risk factors associated with HT: age and gender (males over 55 years old), smoking, cholesterol levels (blood content> 6.5 mmol/L), hereditary predisposition (family history of early cardiovascular disease), dyslipidemia (low HDL cholesterol, high LDL cholesterol), overweight or obesity, and passive lifestyle (Malekzadeh et al., 2013). For example, according to recent statistics, “highly fit individuals with a parental history of hypertension had a 21% and 34% lower risk of developing hypertension, respectively, compared to low fit individuals with a parental history of hypertension” (Diaz & Shimbo, 2013, p. 663).
The evidence shows the significance of a sustainable behavioral change in the patient. As for cultural considerations, African Americans are associated with a significant health-related disparity in HT because the population usually shows higher blood pressure levels. Additionally, as Lackland (2014) observes, “the higher blood pressure levels for African Americans are associated with higher rates of stroke, end-stage renal disease, and congestive heart failure” (p. 135). It means the patient, as well as the healthcare practitioner, should pay great attention to measures aimed to prevent the development of HT-related comorbidities.
Follow-Up and Referral
According to the “2017 Guideline for High Blood Pressure in Adults,” the follow-up for adults with a high risk of blood pressure-related cardiovascular disease should include both non-pharmacologic and antihypertensive drug therapy with a second visit scheduled within one month after the first referral (Rubenfire, 2017). The additional blood pressure measurement must be performed to evaluate the effectiveness of the suggested treatment.
References
Bazzano, L. A., Green, T., Harrison, T. N., & Reynolds, K. (2013). Dietary approaches to prevent hypertension. Current Hypertension Reports, 15(6), 694–702.
Braunwald, E., & Hollenberg, N. K. (2013). Atlas of heart diseases. Hypertension: Mechanisms and therapy. New York, NY: Springer.
Diaz, K. M., & Shimbo, D. (2013). Physical activity and the prevention of hypertension. Current Hypertension Reports, 15(6), 659–668.
Gelfer, M., Cloutier, L., Tobe, S., Lamarre-Cliche, M., Bolli, P., Tremblay, G.,… Tran, K. (2015). Criteria for diagnosis of hypertension and guidelines for follow-up (figure 1).
Khatib, R., Schwalm, J.-D., Yusuf, S., Haynes, R. B., McKee, M., Khan, M., & Nieuwlaat, R. (2014). Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: A systematic review and meta-analysis of qualitative and quantitative studies. PLoS ONE, 9(1), e84238.
Lackland, D. T. (2014). Racial differences in hypertension: Implications for high blood pressure management. The American Journal of the Medical Sciences, 348(2), 135–138.
Malekzadeh, M. M., Etemadi, A., Kamangar, F., Khademi, H., Golozar, A., Islami, F., … Malekzadeh, R. (2013). Prevalence, awareness and risk factors of hypertension in a large cohort of Iranian adult population. Journal of Hypertension, 31(7), 1364–1371.
Okamura, K., Shirai, K., Totake, N., Okuda, T., & Urata, H. (2017). Prospective direct comparison of antihypertensive effect and safety between high-dose amlodipine or indapamide in hypertensive patients uncontrolled by standard doses of angiotensin receptor blockers and amlodipine. Clinical and Experimental Hypertension, 40(2), 99-106.
Rubenfire, M. (2017). 2017 guideline for high blood pressure in adults.
Wise, I. A., & Charchar, F. J. (2016). Epigenetic Modifications in Essential Hypertension. International Journal of Molecular Sciences, 17(4), 451.