Hypertension Case Study
CASE STUDY
Mr. P is a 61-year-old Hispanic male who present to the clinic for a refill of his medications. He was recently seen by the Corporate MD for sinus and allergy problems. PMH sig for HTN (poorly controlled) on diet, Asthma, Benign Prostatic Hypertrophy, chronic sinus problems, Obesity, and occasional back pain. Recent labs reveal LDL of 220.
Chief complaints: Nocturia x several months ? was recently prescribed a medication to control urinary symptoms, but cannot recall the name of the medication
Present medications include, Nasalide 2 sprays each nostril, Sudafed 60 mgm po q 6 hours prn, Naprosyn 375 mgm po QD.
Cholesterol profile is as follows: Total cholesterol 280 mgm/dL, HDL 25 mgm/dl, LDL 189 mg/dL Serum Creatinine .9 /BUN 10/ Weight 100 kgs
V.S = B/P 158/96 on 2 separate occasions, P = 100, RR 24 afebrile
Physical Exam
Skin No rashes ; xanthelasma palpabrarum
HEENT Anicteric, PERRLA, EOMI
Neck/LN No thyromegaly, no lymphadenopathy, no carotid bruits, JVD < 2 cm jugular venous distension
Chest S1 S2 ? no murmurs, occ. premature beat ; apical pulse at 5th intercostals space just lateral to the midclavicular line
CV Lungs clear to A& P
ABD Soft, NT, ND, no HSM
Genit/Rect Deferred
MS/Ext No weakness, no c/c/e
Neuro CN II-XII intact; grossly non-focal
Na (mEq/L) 135
K (mEq/L) 4.0
Cl (mEq/L) 103
CO2 (mEq/L) 21
BUN (mg/dL) 10
Serum Creatinine(mg/dL).9
Glucose (mg/dL) 104
Hgb (g/dL) 13.
Hct (%) 45
Ca (mg/dL) 8.4
Phos (mg/dL) 4.2
Total protein (g/dL) 6.3
Alb (g/dL) 4.2
Total Cholesterol Panel
&#61607; Total cholesterol is 210
&#61607; LDL is 180
&#61607; HDL is 45
&#61607; Triglycerides = 285
Use the information on the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure Guidelines (JNC VII, 2003) (https://newclasses.nyu.edu/access/content/group/6d4dc87e-ddc7-415c-9143-1bdccadaa7a8/Documents/Class%202_%3A%20%20Hypertension%3A%20%20Part%20I/JNC%20VII%3A%20%20Pocket%20Card/JNCVII_express_card.pdf ) AND
Critically appraisal of the ALLHAT TRIAL Research Study (https://newclasses.nyu.edu/access/content/group/6d4dc87e-ddc7-415c-9143-1bdccadaa7a8/Documents/Class%202_%3A%20%20Hypertension%3A%20%20Part%20I/ALLHAT/ALLHAT-%20this%20is%20the%20one.pdf ) TO support the use of a Thiazide Diuretic in the treatment of hypertension in the above case study patient.
The ALLHAT TRIAL Research Study should be appraised for validity and outcome using the RCT CASP tool (https://newclasses.nyu.edu/access/content/group/6d4dc87e-ddc7-415c-9143-1bdccadaa7a8/Documents/Class%202_%3A%20%20Hypertension%3A%20%20Part%20I/CASP%20Tool%20for%20RCTs/casp_rct_tool.pdf ).
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