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This is a research paper on hypertension. Hypertension or high blood pressure is a chronic condition where the blood pressure in the arteries is elevated (Medicineplus 2010, pg 1).The research paper will report on a clinical case study on hypertension. The paper will evaluate and analyze the case study as presented. It will further include recommendations for diagnosis and treatment of the case study based on an informed research. The research paper will similarly provide a reflection as to whether the case study has the potential of being used in evidence-based medicine. In this context, the case study is titled, Pearls in Hypertension Pharmacotherapy and refers to a 76-year old Hispanic woman, RM, who has hypertension and diabetes. She also has peripheral artery disease and lower extremity edema.

Case study analysis and evaluation

The main symptoms associated with hypertension include fatigue, severer headaches, facial redness, and high blood pressure. Signs of hypertension are; systolic blood pressure ranging from 140 to 200mmHg and diastolic blood pressure ranging from 70 to 104 mmHg. For systolic blood pressure, it is considered to be high if it is over 140 mm Hg and low if it is below 120 mmHg at time (Medicineplus 2010, pg 1), hence in this case it is high. For diastolic blood pressure, it is considered to be high if it is over 90 mmHg and low if it is below 80 mm Hg most of the time, hence in this case it is also high. Both systolic and diastolic blood pressures confirm hypertension in this case. Her blood pressure of 160/84 mmHg is too elevated (Medicineplus 2010, pg 1). With 175 pounds in weight for 5'2'' height and body mass index of 32 and a pulse of 70, these describe a very high possibility of hypertension. Normally the body mass index stabilizes at (18.5-24.9).So the body mass index of 32 in this case is too high. A pulse rate of 70 dictates an irregular heartbeat as a normal one is of 72. For diagnosis an assessment of risk factors and comorbidities using physical examinations, history, and laboratory parameters are highly recommended. This is because the comorbidities present influence the medication of a hypertension patient. Tests for renal diseases, electrical activity of the heart and sugar levels are carried out (Medicineplus 2010, pg 1)


For purposes of treatment, hypertension is viewed under: Medication includes; metoprolol XL 50 mg twice a day, triamterene 37.5 mg/ HCTZ 25 mg once a day, furosemide 40 mg once a day, olmesarten 20 mg every bedtime, metformin 1 gram twice a day, clonidine 0.2 mg 4 times a day and as needed, aspirin 81 mg once a day, clopidogrel 75 mg once a day, and ezetimibe 10 mg/simvastatin 40 mg once a day. However for a diabetic patient Metoprolol XL has negative effects as her glucose control is poor. Since poor glucose control is coupled with poor blood pressure control, Metoprolol XL is not fit for hypertension patients with diabetes. For Stage 1 of hypertension which is characterized by a systolic blood pressure of 140 to 159 mm Hg, mono-therapy is of a thiazide, angiotensin-converting enzyme inhibitor, beta-blocker, calcium channel blocker, or a combination is recommended. For stage 2 of hypertension which is characterized by a systolic blood pressure of more than 160 mmHg, 2 drugs  may require to be used and may include thiazide in 2 drug regimes. There are new pharmacologic agents like beta-blocker, CCBs, and ARBs. These ensure that clinical trials provided the basis for making specific recommendations with respect to compelling indications. For example, beta-blockers' association with a reduction in myocardial infarction (MI). Medical doctors recommend a beta-blocker for patients with histories of MI to capitalize on its ability to reduce the likelihood of recurrent MI and to lower the blood pressure. Beta-blockers are however used less in hypertensive patients with diabetes, kidney disease, or stroke. The new medical agents improve the endothelial function and regulatory agencies have approved them. In the recent medical practice, incorporating evidence-based treatment guidelines indicates that hypertension patients are being treated more appropriately and hypertension is more controlled. However, in a situation where the blood pressure does not hit the targeted level, the dose is increased if it was not at maximum already.

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Behavioral modification also aid in treating hypertension

Some diet restrictions of simple carbohydrates and saturated fats are recommended for purposes of weight loss. Weight loss is necessary for a diabetic patient because of the poor blood glucose control they possess. Weight loss lowers the systolic blood pressure with 5 to 20 mmHg. Specifically weight loss is recommended for obese patient as excess weight provides the underpinnings for metabolic syndrome which incorporates hypertension and diabetes. Excess weight also indicates endothelial dysfunction. A diet approach to stop hypertension should include a diet rich in fruits, vegetables and enriched with low-fat dairy products as a source of calcium. In addition a diet with low sodium content is recommended for hypertension patients as this lowers the blood pressure with 2 to 8 mmHg above what is achieved by weight loss. Physical activity is necessary in burning calories, controlling weight gain and weight loss. Although physical activities may depend on age, they may include: walking and brief exercises. At the same time, body mass index should be maintained a normal levels (18.5-24.9 Kg/m2). This helps in stabilizing the blood pressure. Alcohol restrictions are necessary for hypertension patients because excess alcohol gives rise to high blood pressure and poor adherence to medical regimens. All in all different risks of hypertension require specific treatment procedures. This is a case of high risk: hypertension, diabetes and dyslipidemia. Lifestyle modifications as seen earlier can address this high-risk case study.

In addition to the signs symptoms, diagnosis and treatment procedures of hypertension detailed in the case study, I would recommend a few details in this context. That the following symptoms to be considered; chest pains, nausea, breathing problems, blood in urine, problems with vision and dizziness. For purposes of diagnosis, the physician should consider the risk factors for hypertension, such as high cholesterol and smoking. Electrolyte test should be carried out to measure sodium and potassium content in the blood (MedicineNet 2010, pg 7).In treating hypertension patients with diabetes and chronic kidney diseases, the target blood pressure should be lower than 140/90. In case of smokers, patients should quit smoking. In case of pregnant women the medications should be adjusted accordingly for the sake of the foetus and the mother. Considerably, where blood pressure is successfully lowered, frequent checkups and adapting preventive measures is necessary to prevent a relapse of hypertension. It is worth noting that hypertension can be prevented by eating properly, exercising and adapting healthy lifestyles. Similarly, the control of hypertension in its early stages is significant in preventing the damage of critical organs and conditions like stroke and heart failure (Medical news today 2009, pg 1)

This case study has the potential of being used in evidence-based medicine

The medication in the case study, recommended exercises, diet restrictions and proposals, alcohol restriction and detailed tests affirm this. The new drugs and the continued of the old drugs are very effective. The selective use of medication depending on the condition of the patient is of great essence.  The handling of the high risks involved in the case study as a result of triple infection of hypertension, diabetes and dyslipidemia is highly approved. Hence the case study can be used in evidence-based medicine.

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