Question

Case Study Primary hypertension has been diagnosed in Ms. G., a 47-year-old woman. Blood pressure readings have been ranging between 158 and 172 mm Hg systolic and 94 and 110 mm Hg diastolic. Average blood pressure over the past month has been 156/96 mm Hg. There is a strong family history of hypertension. Ms. G. is a single parent of two adolescents. She is also trying to keep up with her responsibilities as a full-time assistant professor of education at a local urban university and works more than 40 hours a week. There is no evidence of renal insufficiency or cardiac damage at this time, nor is there evidence of retinopathy or other signs and symptoms of end-organ disease. No other problems are reported. Ms. G. is started on 50 mg of hydrochlorothiazide daily with a small dose of the ß-blocker atenolol. 1. Discuss the antihypertensive effects of hydrochlorothiazide. What sort of information must you share with this patient to increase compliance and decrease side effects? What should be included in her daily regimen? What other nonpharmacologic measures should you tell the patient about that can help her control her blood pressure? 2. 3.

Answer 1

1. Antihypertensive effect of hydrochlorothiazide

              *Hydrochlorothiazides are classified as diuretics used to control blood pressure.

              * It act by enhance the excretion of sodium and water from the body.

              * Loss of water result in decreasing plasma volume and cardicac output which

                 result in drop in blood pressure.

              * Sodium excretion result in low sodium level in the body which relax the vascular smooth

                 muscle due to sodium depletion in the vascular smooth muscle leads to low pheripheral

                 vascular resistance.

              * Low pheripheral vascular resistance result in low blood pressure level in the body.

2. * Instruct the patient that low sodium diet will help to reduce the dose of diuretics needed for

   control blood pressure.

   * DASH (Dietry appproaches to stop hypertension) diet which include fruits,vegetables,whole grains

      and low fat products are recommended for patient to control hypertension.

3. Non pharmacological measures to control blood pressure

               * Use of a low sodium diet plan.

               * Regular exercises to lose weight.

               * Avoid overconsumption of alcohol.

               * Reduce use of saturated fat and cholesterol(LDL) containing foods.

               * Quit smoking and reduce intake of caffeine containing drinks.