Physical examination and diagnostic management of hypertensive patients

Hypertensive Patient Case Study

Specific physical examinations in any hypertensive patient

Accuracy in the measurement of blood pressure is the basic aspect of diagnosis. Therefore, we take it over several weeks. On each visit, normally at least three blood pressure readings are taken with the difference of 2 minutes using mercury manometer.

Palpation of all peripheral pulses should necessarily be carried out. Absent, weak, or delayed femoral pulses are the sign of coarctation of the aorta or serious peripheral vascular disease. To identify any symptom of initial or extreme stage of chronic or severe hypertensive retinopathy along with arteriovenous nicking or difference in vessel wall, we conduct funduscopic examination of the eyes (Madhur & Maron, 2014).

Malignant Hypertension

Malignant hypertension is the type of serious high blood pressure that increases quickly and can damage some organ. 140/90 is considered "Normal" blood pressure. In the patient of malignant hypertension usually blood pressure increases above 180/120 (WebMD, 2016).

Secondary Hypertension

The Secondary hypertension is the type in which high blood pressure is caused by another disease.

Renal Hypertension

The blood pressure that is increased due to kidney disease is called Renal hypertension or renovascular hypertension.

John's stage of hypertension based on JNC 8 guidelines.

Stage 2 hypertension - BP in surgery/clinic is ?160/100 mm Hg and ABPM or HBPM is ?150/95 mm Hg.

Treatment goals for Frank

In the case of John, to decrease blood pressure to less than 140/90, treatment with medication is given. Healthy life style is an important aspect in John's high blood pressure treatment. A healthy life style in his treatment can be achieved by;

Losing weight

Quitting smoking

Eating a healthy diet, including the DASH diet (eating more fruits, vegetables, and low fat dairy products, less saturated and total fat)

And taking drugs to treat high blood pressure, including:

Angiotensin-converting enzyme (ACE) inhibitors

Angiotensin II receptor blockers (ARBs)

Diuretics

Beta-blockers

Calcium channel blockers (WebMD, 2016).

Patient education for a patient like FRANK

We provide adequate counseling and materials regarding advantages of drugs and their undesired adverse effects that are sometimes experienced. This information is to make him able to adopt choices based on correct knowledge.

To provide details of patient organizations these provide helpful platforms to exchange opinions and information.

Non-pharmacologic and pharmacologic management of hypertension

Non-pharmacologic

Weight loss helps to refrain from hypertension

Limit alcohol consumption for man it should be limited to not more than 30 ml of ethanol a day and 15 ml ethanol for women and lighter weight people.

Sodium intake should be limited to no more than 100 mmol/d

Maintain appropriate consumption of dietary potassium (approximately 90 mmol/d)

Maintain appropriate consumption of dietary calcium and magnesium for general health

Quit smoking and decrease consumption of dietary saturated fat and cholesterol for general cardiovascular health

Do at least 30 minutes aerobic exercise daily for most days (range of approximate SBP reduction, 4-9 mm Hg).

Pharmacologic

If changes in lifestyle are inadequate in achieving the objective of controlling blood pressure (BP), there are various drugs available for the treatment and management of hypertension.

Different anti-hypertensive medications, mechanism of action and side effects

Diuretics

Mostly three types of diuretic drugs are used to treat hypertension i.e. thiazide diuretics such as hydrochlorothiazide or chlorthalidone.

Adverse Effects:

Diuretics increase the discharge of potassium and may cause hypokalemia (low blood potassium concentration) which lead to irregular heartbeats, and muscular weakness.

Angiotensin Converting Enzyme Inhibitors (ACEIS)

In the treatment of hypertension, ACEIs are most commonly used due to their effectiveness, less side effects and to decrease the complications of hypertension such as heart attacks and strokes.

Adverse Effects: 10 to 20% of subjects develop an irritant cough.

Angiotensin Receptor Blockers (ARBS):

Renin angiotensin system (RAS) is also blocked by ARBs, same as ACEIs, but it works differently; for instance, it blocks the functions of angiotensin II in the tissues instead of the generation of angiotensin II, which is the function of ACEIs.

Adverse Effects: As explained, the complaints of irritant cough have never been reported by these drugs, but have a similar range of different adverse actions to ACEIs.