Question

HYPERTENSION CASE STUDY PN3 LAB Week 4 Scenario You are working in the hospital medical ward and start your morning assessments Mr HAPPY is a 50-year-old accountant who was admitted 2 days ago to hospital following a blackout whilst watching a football match with his son. His preliminary examination reveals bruising to his left arm and upper thigh for which he has been prescribed paracetamol 1g four times daily and as required ibuprofen 400 mg three times a day His past medical history indicates that he is on no medication and seemed to be a reasonably fit man for his age with no existing diagnosed medical conditions. On examination he is slightly overweight at 81 kg, he smokes 20 cigarettes per day and drinks approximately 30 units of alcohol per week. His blood pressure on admission was 165/80 mmHg with a heart rate of 90 beats per minute. This degree of raised blood pressure and heart rate has been maintained over the last 48 hours. He is subsequently diagnosed as having hypertension. Questions 1. What is hypertension? 2. What are the appropriate treatment targets for this patient's blood pressure? 3. Besides blood pressure, what other advice and treatment does this patient require to ensure his risk of a cardiovascular event is reduced? Give clear reasons for your advice and explain the risks associated with not taking this advice. 4. What are the main classes of drug used to treat hypertension? 5. Which class of drug would be appropriate first-line treatment for Mr HA? How would this treatment choice be affected if the patient had been of Afro-Caribbean origin?

Answer 1

1.Hypertension refers to elevated blood pressure level from the normsl range. When a systolic blood pressure is more than 120 and diastolic blood pressure more than 80 can be an indicator of hypertension

2.The target treatment appropriate for this patient in regards to the blood pressure is to maintain blood pressure under control ranging at 120/80mmHg

3.The other advice required to reduce the risk of cardiovascular issues are

• Increased weight has to be managed within normal limits because excess weight can increase the level of LDL and cause hyperlipidemia leading to heart disease. It also will increase the work load of heart to pump blood and this increasing the blood pressure. It poses an individual to be at very high risk for diabetes and aggravate the condition of heart disease.In simple it can increase the risk for heart attack and stroke
• Smoking is injuries to health in all ways.When one smokes there is a chance to decrease the oxygen supply to the heart and causing ischemia or infarction. It can increase the heart disease by leading to lot of clots which can cause heart attack. It leads to deposition of fats in the blood vessels resulting in atherosclerosis which can cause chest pain and heart attack.It can put you at risk for peripheral vascular disease and aortic aneurysm. It will decrease the life span by 24%
• Alcohol will weakens the function of myocardial muscle causing dysfunction of heart by inflammation. This leads to heart failure and death.

Hence avoiding smoking and alcohol, maintaining normal weight can prevent from the above consequences .

4.The main classes of drugs used to treat hypertension are

• Angiotensin converting enzyme inhibitor (it prevents the formation of angiotensin)
• Beta blockers (this will decrease the heart rate and reduce pumping to decrease blood pressure)
• Calcium channel blockers (inhibiting the function of calcium in the cells)
• Diuretics or thiazide diuretics (removes excess fluids and sodium)
• Angiotensin 2 receptor blockers (blocks functionof angiotensin)
• Central agonist( blocks the nerve function responsible to elevate blood pressure)
• Vasodilator (dialates the blood vessels)
• Peripheral adrenergic blockers (inhibits the function directly at the central nervous system)