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Manage Hypertension in a 45-Year-Old Patient
- 1. Hypertension--Patient-Based Learning John Brill, MD & Alan Wolkenstein, MSW August 2004 • Learn to screen for, diagnose and treat hypertension • Learn to tailor hypertension management to each patient’s needs, particularly recommendations for therapeutic lifestyle changes. • Learn to be a family physician: use time as your ally, develop a long-term relationship with patients, cope with uncertainty, find out and use your patient’s life story to help improve their health. A 45- year old man presents as a new patient. He recently had his blood pressure checked during a pre-employment physical. He was told that it was high and that he needed to see a physician. He doesn’t recall that it was ever high before. His past medical history is basically unremarkable. He takes no regular meds but uses Tums most days, has no allergies. He works at as a welder at a local factory, first shift. He is a high school graduate and did some tech courses in the navy. He is married with 3 children aged 15-20. He smokes 1 pack/day with a total smoking history of 38 pack-years. He drinks beer on weekends and sometimes after work. Enjoys hunting and fishing, watching football and basketball. He plays basketball in the driveway with his two teenaged sons pretty often, but doesn’t get any other exercise. On exam, height is 72”, weight 110 kg. His blood pressure in the office is 160/100. Exam is otherwise unremarkable. What further history do you need to obtain? What are you thinking about his blood pressure? What will you recommend? What measures might increase the likelihood of your recommendations being followed and sustained? He returns in one month, having attempted to comply with your recommendations. Blood pressure is 156/95. What will you recommend? What measures might increase the likelihood of your recommendations being followed and sustained? A friend has told him he should have an EKG and a stress test. What is the data?
- 2. He returns in one month, having attempted to comply with your recommendations. He returns in one month. Blood pressure is 138/86. What will you recommend? What will you tell him about: taking aspirin; drinking coffee? How would your evaluation & treatment have differed if the patient was: 20 years old? African-American? Wanted to try something ‘natural’? An airline pilot? Reported that his blood pressure was normal when he checked it at home and in stores How will you assess and use the following information? Patient’s relationships with others Stressors Coping skills
- 3. Health beliefs about high blood pressure Signs/symptoms of anxiety/depression Effect of the high blood pressure on his life Sexual functioning Resources: Chobanian AV, Bakris GL, Black HR, Cushman WC. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 2003; 289:2560. Norman M Kaplan, MD, Burton D Rose, MD Therapy in essential hypertension: Recommendations From UpToDate, 2004 Available online through Aurora library website Major outcomes in high-risk hypertensive patients randomized to angiotensin- converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288:2981.