Case Study: hypertension
Scenario:
M.P. is a 65-year-old African-American woman who comes to your clinic for a follow-up
visit. She was diagnosed with hypertension (HTN) 2 months ago and was given a
prescription for a thiazide diuretic but stopped taking it 2 weeks ago because “it made
me dizzy and I kept getting up during the night to empty my bladder.” During today's
clinic visit, she expresses fear because her mother died of a cerebrovascular accident
(CVA, stroke) at her age, and M.P. is afraid she will suffer the same fate. She states,
“I've never smoked and I don't drink, but I am so afraid of this high blood pressure.” You
review the data on her past clinic visits.
Chart View
Family History:
Mother, died at age 65 years of CVA
Father, died at age 67 years of myocardial infarction (MI)
Sister, alive and well, age 62 years
Brother, alive, age 70 years, has coronary artery disease, HTN, type II diabetes
mellitus (DM)
Patient Past History:
Married for 45 years, two children, alive and well, six grandchildren
Cholecystectomy, age 42 years
Hysterectomy, age 48 years
Blood Pressure Assessments:
January 2: 150/92
January 31: 156/94 (Given prescription for hydrochlorothiazide [HCTZ] 25 mg PO every
morning)
February 28: 140/90
1. According to the most recent Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure, M.P.'s blood pressure falls under
which classification?
M.P’s blood pressure falls under the Stage 1 classification since it is 140/90.
2. What is primary and secondary hypertension?
Primary Hypertension: Hypertension that is linked to genetics, poor diet and lack of
exercise, also obesity.
Secondary Hypertension: Secondary hypertension is caused by renal disease.
3. What could M.P. be doing that is causing her nocturia?
, M.P is experiencing nocturia because she states that she was taking thiazide dieuretic . Which
treats hypertension and also fluid retention in the body (edema). It reduces the kidney’s ability to
retain Na and Water, therefore she is urinating a lot.
CASE STUDY PROGRESS
During today's visit, M.P.'s vital signs were BP: 162/102, P: 78, R: 16, T: 98.2 ° F (36.8 °
C). Her most recent basic metabolic panel (BMP) and fasting lipids were within normal
limits. Her height is 5 ft, 4 in., and she weighs 110 lb. She tells you that she tries to go
on walks but does not like to walk alone so has done so only occasionally.
4. What risk factors does M.P. have that increase her risk for cardiovascular disease?
M.P’s blood pressure is hypertensive. It has advanced to stage 2 hypertension which is over
160/100. This can increase the risk of her having a cardiovascular disease. Also her sedentary
lifestyle can also increase the risk of a C.D.
5. What are additional contributing factors for hypertension?
The additional contributing factors for hypertension include age /gender, (premenopausal women
have less estrogen), sedentary lifestyle, high blood pressure, and stress.
CASE STUDY PROGRESS:
Because M.P.'s BP continues to be high, the internist decides to put her on another drug
and recommends that she try again with the HCTZ.
6. According to national guidelines, what drug category or categories are recommended
for
M.P. at this time?
The drugs that are recommended for patient’s hypertension
Calcium Channel Blockers such as Diltiazem (cardizem)
Beta Blockers: metropolol (Lopressor)
ACE Inhibitos: Catopril (capoten)
7. What are some complications of hypertension? Give at least 3.
Some of the complications for chronic hypertension include heart attack, Hemorrhagic
stroke, Decrease renal perfussion because of vasoconstriction.
8. M.P. goes on to ask whether there is anything else she should do to help with her
HTN. She
asks, “Do I need to lose weight?” Look up her height and weight for her age on a body
mass
index chart. Is she considered overweight?
She is not considered to be overweight. Her BMI is considered to be 18.9 which is
considered normal and healthy
Scenario:
M.P. is a 65-year-old African-American woman who comes to your clinic for a follow-up
visit. She was diagnosed with hypertension (HTN) 2 months ago and was given a
prescription for a thiazide diuretic but stopped taking it 2 weeks ago because “it made
me dizzy and I kept getting up during the night to empty my bladder.” During today's
clinic visit, she expresses fear because her mother died of a cerebrovascular accident
(CVA, stroke) at her age, and M.P. is afraid she will suffer the same fate. She states,
“I've never smoked and I don't drink, but I am so afraid of this high blood pressure.” You
review the data on her past clinic visits.
Chart View
Family History:
Mother, died at age 65 years of CVA
Father, died at age 67 years of myocardial infarction (MI)
Sister, alive and well, age 62 years
Brother, alive, age 70 years, has coronary artery disease, HTN, type II diabetes
mellitus (DM)
Patient Past History:
Married for 45 years, two children, alive and well, six grandchildren
Cholecystectomy, age 42 years
Hysterectomy, age 48 years
Blood Pressure Assessments:
January 2: 150/92
January 31: 156/94 (Given prescription for hydrochlorothiazide [HCTZ] 25 mg PO every
morning)
February 28: 140/90
1. According to the most recent Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure, M.P.'s blood pressure falls under
which classification?
M.P’s blood pressure falls under the Stage 1 classification since it is 140/90.
2. What is primary and secondary hypertension?
Primary Hypertension: Hypertension that is linked to genetics, poor diet and lack of
exercise, also obesity.
Secondary Hypertension: Secondary hypertension is caused by renal disease.
3. What could M.P. be doing that is causing her nocturia?
, M.P is experiencing nocturia because she states that she was taking thiazide dieuretic . Which
treats hypertension and also fluid retention in the body (edema). It reduces the kidney’s ability to
retain Na and Water, therefore she is urinating a lot.
CASE STUDY PROGRESS
During today's visit, M.P.'s vital signs were BP: 162/102, P: 78, R: 16, T: 98.2 ° F (36.8 °
C). Her most recent basic metabolic panel (BMP) and fasting lipids were within normal
limits. Her height is 5 ft, 4 in., and she weighs 110 lb. She tells you that she tries to go
on walks but does not like to walk alone so has done so only occasionally.
4. What risk factors does M.P. have that increase her risk for cardiovascular disease?
M.P’s blood pressure is hypertensive. It has advanced to stage 2 hypertension which is over
160/100. This can increase the risk of her having a cardiovascular disease. Also her sedentary
lifestyle can also increase the risk of a C.D.
5. What are additional contributing factors for hypertension?
The additional contributing factors for hypertension include age /gender, (premenopausal women
have less estrogen), sedentary lifestyle, high blood pressure, and stress.
CASE STUDY PROGRESS:
Because M.P.'s BP continues to be high, the internist decides to put her on another drug
and recommends that she try again with the HCTZ.
6. According to national guidelines, what drug category or categories are recommended
for
M.P. at this time?
The drugs that are recommended for patient’s hypertension
Calcium Channel Blockers such as Diltiazem (cardizem)
Beta Blockers: metropolol (Lopressor)
ACE Inhibitos: Catopril (capoten)
7. What are some complications of hypertension? Give at least 3.
Some of the complications for chronic hypertension include heart attack, Hemorrhagic
stroke, Decrease renal perfussion because of vasoconstriction.
8. M.P. goes on to ask whether there is anything else she should do to help with her
HTN. She
asks, “Do I need to lose weight?” Look up her height and weight for her age on a body
mass
index chart. Is she considered overweight?
She is not considered to be overweight. Her BMI is considered to be 18.9 which is
considered normal and healthy
