Mr Martin visits the office with anxiety over his high blood pressure. Hypertension, which is the sustained blood pressure over 140/90 mmHg as stated in the 2019 guidelines of the American College of Cardiology (ACC) and American Heart Association (AHA), is the patient diagnosis (Bello et al., 2021). Mr. Martin’s 150/85 mmHg blood pressure readings and their further measurements over 130/80 mmHg are diagnostic of this condition. Hypertension is a very significant risk factor for cardiovascular diseases, including heart attack and stroke, and it may cause other health complications if not well monitored and controlled. Its widespread adult population and Mr Martin’s previous history of being overweight for more than ten years and not seeking medical attention make him more vulnerable to the complications of high blood pressure.
Differential Diagnosis
Based on Mr. Martin’s clinical presentation, two differential diagnoses come into consideration: Secondary hypertension and isolated systolic hypertension. Secondary hypertension is when a person’s blood pressure is high and is connected to a particular underlying condition, unlike primary hypertension, which has no particular cause and is more common. Several causes that result in secondary hypertension are renal failure, endocrine dysfunctions like hyperaldosteronism and vascular abnormalities like coarctation of the aorta (Rossi et al., 2020). Mr Martin’s clinical presentation with no specific disease symptoms like oedema indicating kidney disease and no history suggesting endocrine abnormalities point to a lesser likelihood of secondary hypertension. However, his prolonged intentional disengagement from his healthcare should be addressed with further diagnostic tests. The diagnostic process for the cause of secondary hypertension involves checking renal function through blood tests, a basic metabolic panel, and maybe radiological or hormonal studies if suspicion is high based on the initial test results.
Isolated systolic hypertension is a condition where the systolic blood pressure is above 140 mmHg and the diastolic blood pressure is below 90 mmHg. It is particularly present in elderly patients cases, as their arteries have been stiffening (Tsai et al., 2020). In this respect, the difference between Mr Martin and the others is particularly notable since he is in his mid-50s when arterial stiffness becomes a more significant factor. On the other hand, Mr. Martin’s blood pressure readings, which include elevated diastolic pressures, do not follow the ISH-related pattern. This state is of paramount importance to be identified because it is known that it increases the risk of cardiac events in the same way as other types of hypertension. Confirmation of the elevated blood pressure pattern is based on accurate blood pressure measurements over time rather than a single assessment. It is less likely that Mr. Martin has ISH, as his blood pressure readings suggest. However, this needs to be considered as a part of his ongoing management and monitoring.
Diagnostic Tests
The evaluation of Mr. Martin’s high blood pressure includes a complex set of diagnostic factors related to primary and secondary factors contributing to his health status. Step one is the Basic Metabolic Panel (BMP), which provides information about kidney function through the creatinine, BUN, and electrolyte levels that reflect the general metabolic condition of the body. However, with the complicated interrelationship between hypertension and kidney health, renal function comprehension opens the way to understand the underlying cause of his high blood pressure or to assess the renal damage (Ozemek et al., 2020).
Similarly, the Lipid Profile is essential since it measures cholesterol and triglycerides, and in the case of drugs, it is needed to lower the risks of cardiovascular events. An Electrocardiogram (ECG) is indeed a must for recognizing cardiac consequences of long-term hypertension, such as left ventricular hypertrophy, which, in addition to extra workload, indicates future development of heart failure (Jones et al., 2020). TSH test will help to rule out the thyroid disorders that might be associated with Mr Martin’s elevated blood pressure. Altogether, these studies’ diagnostic techniques give medical staff a general idea of the condition of Mr Martin’s health, and they guide doctors in the development of a specific and individualized treatment plan for his hypertension.
Treatment, Education and Follow-up
Mr Martin’s treatment should kick off with lifestyle adjustments like dietary modifications, physical activity, and weight loss, which have been confirmed to be very effective at lowering blood pressure. Due to stage 2 hypertension of Mr Martin, treatment with a diuretic drug, chlorthalidone and ACE inhibitor, lisinopril, may be considered, with the goal of reducing his blood pressure below 130/80 mmHg (Ernst & Fravel, 2022). Adverse events of the medication should be closely monitored, and the regimen should be altered if required. Follow-up visits should be scheduled in another 30 days to check the control of the blood pressure and compliance with the medication. Healthcare visits might be scheduled partly by telemedicine in terms of saving time and the ability to keep under control. Patient education should emphasize the importance of sticking to lifestyle modifications and medication regimens, understanding uncontrolled hypertension risks, and, on the other hand, the advantages of regular monitoring and follow-up. It would be of paramount importance to educate Mr Martin about the seriousness of his condition and the complications that can result from uncontrolled hypertension (Adinkrah et al., 2020). Resources that contain dietary guidelines, physical activity suggestions, and stress management strategies can aid in his efforts to achieve his goal of improving his health.
References
Adinkrah, E., Bazargan, M., Wisseh, C., & Assari, S. (2020). Adherence to Hypertension Medications and Lifestyle Recommendations among Underserved African American Middle-Aged and Older Adults. International Journal of Environmental Research and Public Health, 17(18), 6538. https://doi.org/10.3390/ijerph17186538
Bello, N. A., Zhou, H., Cheetham, T. C., Miller, E., Getahun, D. T., Fassett, M. J., & Reynolds, K. (2021). Prevalence of Hypertension Among Pregnant Women When Using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines and Association With Maternal and Fetal Outcomes. JAMA Network Open, 4(3), e213808. https://doi.org/10.1001/jamanetworkopen.2021.3808
Ernst, M. E., & Fravel, M. A. (2022). Thiazide and the Thiazide-Like Diuretics: Review of Hydrochlorothiazide, Chlorthalidone, and Indapamide. American Journal of Hypertension, 35(7). https://doi.org/10.1093/ajh/hpac048
Jones, N. R., McCormack, T., Constanti, M., & McManus, R. J. (2020). Diagnosis and management of hypertension in adults: NICE guideline update 2019. British Journal of General Practice, 70(691), 90–91. https://doi.org/10.3399/bjgp20x708053
Ozemek, C., Tiwari, S., Sabbahi, A., Carbone, S., & Lavie, C. J. (2020). Impact of therapeutic lifestyle changes in resistant hypertension. Progress in Cardiovascular Diseases, 63(1), 4–9. https://doi.org/10.1016/j.pcad.2019.11.012
Rossi, G. P., Bisogni, V., Rossitto, G., Maiolino, G., Cesari, M., Zhu, R., & Seccia, T. M. (2020). Practice Recommendations for Diagnosis and Treatment of the Most Common Forms of Secondary Hypertension. High Blood Pressure & Cardiovascular Prevention, 27(6), 547–560. https://doi.org/10.1007/s40292-020-00415-9
Tsai, T., Cheng, H., Chuang, S., Chia, Y., Soenarta, A. A., Minh, H. V., Siddique, S., Turana, Y., Tay, J. C., Kario, K., & Chen, C. (2020). Isolated systolic hypertension in Asia. The Journal of Clinical Hypertension, 23(3), 467–474. https://doi.org/10.1111/jch.14111
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