The successful treatment of high blood pressure lies in early recognition of this disease and the accurate medication prescription that takes into consideration all patient-specific factors. Hypertension is most prevalent among older patients, with approximately two-thirds of Americans age 60 and older having this condition (Alshami et al., 2018). This case study evaluates the most suitable treatment regimen for the patient, includes a thorough description of the pharmacological data, as well as provides the reasoning to support this choice of medication.
The patient presented in this case study is a 65-year old woman with stage 2 hypertension, who has been taking a thiazide diuretic. This type of antihypertensive drug is one of the three first-line choices for the treatment of hypertension, and the most suitable among them for older people (Burnier et al., 2019). Burnier et al. (2019) state that “the benefits of volume control and natriuresis are high and the reductions in morbidity and mortality are clinically significant” when using diuretics (p. 1574). Due to the persistence of elevation and previous exposure to the drug without any reported adverse effects, it is recommended to continue the treatment with several modifications.
To provide a sustainable effect, angiotensin-converting enzyme (ACE) inhibitors will be added to the treatment. Mann (2020) states that “ACE inhibitors and ARBs have a cardioprotective effect independent of blood pressure lowering in patients at high risk for a cardiovascular event.” ACE inhibitors have been shown to reduce mortality in patients with hypertension (Mann, 2020). However, this drug will not be combined, but used sequentially with a thiazide diuretic, as this strategy has shown to control high pressure with the least amount of side effects (Mann, 2020). Amlodipine can be prescribed to the patient to allow greater control over high blood pressure, albeit at a low dose of 5mg/day initially, up to 10mg/day if necessary.
It is essential to inform the patient regarding the right doses, potential side effects, and drug interactions. Regarding the exact type of diuretic, chlorthalidone and indapamide possess a higher potential to reduce blood pressure than hydrochlorothiazide at the same dosage (Mann, 2020). Chlorthalidone, 25 mg/day, as the preferred choice of antihypertensive drug, will be prescribed to the patient as the initial dose, increasing to 50mg/day if the situation does not change or worsens.
The patient will be taught about the severity of potential side effects in accordance with guidelines. The most common side effects include headaches, hypotension, nausea, flushing, and sometimes tachycardia (Alshami et al., 2018). The patient will be asked to keep track of her blood pressure levels throughout the day. The vital data to monitor will be BP, along with any occurring side effects, and adherence to the prescribed intake of medications. It will be essential for the patient to change her dietary habits to reduce salt intake (Mann, 2020). Alcohol and smoking are considered high-risk factors for hypertension and must be avoided, while physical activity is highly encouraged (Unger et al., 2020). To check the adherence and the effects of the treatment, the patient will be asked to visit the physician every two weeks if possible. Lifestyle changes can allow the patient to lower or completely negate this condition, therefore, after three months of treatment combined with these guidelines, the patient will be examined for the necessity of further medication intake.
Alshami, A., Romero, C., Avila, A., & Varon, J. (2018). Management of hypertensive crises in the elderly. Journal of geriatric cardiology : JGC, 15(7), 504–512. Web.
Burnier, M., Bakris, G., & Williams, B. (2019). Redefining diuretics use in hypertension. Journal of Hypertension, 1. Web.
Mann, J. (2020). Choice of drug therapy in primary (essential) hypertension. UpToDate. Web.
Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., Ramirez, A., Schlaich, M., Stergiou, G. S., Tomaszewski, M., Wainford, R. D., Williams, B., & Schutte, A. E. (2020). 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension, 75(6), 1334–1357. Web.