Question

AJ is a 50-year-old white male who presents for follow-up of his hypertension. AJ is not a diabetic and has normal renal function. He is adherent with a low-sodium diet, exercises 150 minutes weekly, and is taking his hydrochlorothiazide 25mg PO daily. His home blood pressure logs and the clinic reading reveal blood pressures in the range 150-160/90-100. The rest of his vitals including heart rate are normal, as is his examination. He has no known drug allergies. His only other medication is cetirizine 10mg PO daily for allergic rhinitis.

1. Do you have any counseling points and monitoring parameters for AJ’s plan of care?

Answer 1

Ans) Recommendation for AJ's regimen to reach his goals:
• Systolic BP is the most important and difficult component in virtually all patient types (most patients with hypertension will reach DBP goal once systolic is controlled)
• Lifestyle modifications:
o Weight reduction (maintain normal weight, BMI: 18.5-24.9 kg/m2) → Appx. SBP reduction 15-20 mmHg/10 kg weight loss
o DASH diet (dietary approaches to stop hypertension) → 8 -14 mmHg
o Physical activity (30 min/day, most days of the week) → 4-9 mmHg
o Decrease sodium intake (less than 2.4 g Na or 6 g NaCl) → 2-8 mmHg
o Moderate alcohol consumption (≤ 2 drink/day for men and ≤1 drink/day for women) → 2-4 mmHg

Counselling and monitoring parameters for AJ:

1. Provide the patient's BP reading and explain what it means (e.g., high, low, normal, borderline). Encourage patient to monitor BP at home and instruct the patient to call health care provider if BP exceeds high or low limits set by health care provider.
2. Hypertension is usually asymptomatic and symptoms (e.g., nosebleeds) do not reliably indicate BP levels.
3. Hypertension means high BP and does not relate to a "hyper" personality.
4. Long-term therapy and follow-up care are necessary to treat hypertension. Therapy involves lifestyle changes (e.g., weight management, sodium reduction, smoking cessation, regular physical activity) and, in most cases, medications.
5. Therapy will not cure, but should control hypertension.
6. Controlled hypertension usually results in an excellent prognosis and a normal lifestyle.
7. Explain the potential dangers of uncontrolled hypertension (e.g., target organ disease).