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Addressing Hypertension, Obesity, and Hyperlipidemia in Mrs. Lyons: Treatment Recommendations and Interventions

 

Mrs. Lyons is a 57-year-old African American female who recently developed headaches and had an elevated blood pressure reading at her work health fair. Her blood pressure was taken at the health fair, and the reading was 168/99. She has returned to the drugstore three times to take her blood pressure. The readings have been: 145/90, 150/89, 140/88. At the health fair, she was told her BMI is elevated. Her cholesterol levels were also done at the health fair, and the results were: total cholesterol level of 250, LDL 138, HDL 48, and Triglycerides 170. She has not been to see a primary care provider in over 5 years. At her last office visit, which was 5 years ago, her blood pressure was (135/95). Her LDL and triglycerides were also elevated at that time. The patient was supposed to monitor her blood pressure at home and trial diet and lifestyle changes. She was supposed to return for a follow-up with her blood pressure log and for a recheck of her labs. She, unfortunately, did not do this. Today in the clinic, her vital signs are: BP 146/92, HR 90, Temp 98.4, RR 12, O2 98%, Height 5’5, Weight 220 lbs, BMI 36.6 She is not currently taking any medications. She has NKDA. Family history: her brother and sister both have been diagnosed with hypertension and DM. Diagnoses for the patient are HTN, Obesity, and Hyperlipidemia.
Q1. Please briefly discuss the first-line treatment recommendations from JNC8, and the AHA/ACC for a patient with no other major comorbidities.
Q2. What are the recommended medications to start this specific patient on? Please provide the drug class, generic & trade name, and initial starting dose.
Q3. Please discuss the mechanism of action of each of the drugs you listed.
Q4. Please discuss the side effect profile of each medication you listed.
Q5. Are there any interactions between any of the medications you prescribed?
Q6. What other non-pharmacological interventions would be

 

Sample Answer

Addressing Hypertension, Obesity, and Hyperlipidemia in Mrs. Lyons: Treatment Recommendations and Interventions

Q1. First-Line Treatment Recommendations

According to the Eighth Joint National Committee (JNC8) guidelines and the American Heart Association/American College of Cardiology (AHA/ACC), for a patient like Mrs. Lyons without major comorbidities, initial treatment for hypertension typically involves lifestyle modifications such as dietary changes, weight loss, exercise, and sodium restriction. If these changes do not effectively lower blood pressure, medication may be initiated.

Q2. Recommended Medications

For Mrs. Lyons, considering her diagnoses and blood pressure readings, starting antihypertensive medications such as an ACE inhibitor or angiotensin II receptor blocker (ARB) would be appropriate. An initial starting dose of Lisinopril (Prinivil, Zestril) 10 mg once daily can be considered.

Q3. Mechanism of Action

– Lisinopril: It is an ACE inhibitor that works by inhibiting the angiotensin-converting enzyme, leading to vasodilation and reduced blood pressure.

Q4. Side Effect Profile

– Lisinopril: Common side effects include cough, dizziness, and hyperkalemia. Rare but serious side effects can include angioedema and renal impairment.

Q5. Medication Interactions

There are potential interactions between Lisinopril and nonsteroidal anti-inflammatory drugs (NSAIDs) which may reduce the effectiveness of ACE inhibitors in lowering blood pressure. It is important to monitor renal function when combining these medications.

Q6. Non-pharmacological Interventions

In addition to medication, non-pharmacological interventions for Mrs. Lyons should include:

– Dietary Modifications: Encourage a heart-healthy diet low in saturated fats and cholesterol.
– Exercise: Recommend regular physical activity to aid weight loss and improve cardiovascular health.
– Weight Loss: Support gradual weight reduction through a combination of diet and exercise.
– Regular Monitoring: Stress the importance of consistent blood pressure monitoring at home and regular follow-ups with healthcare providers.

By combining medication with lifestyle changes and monitoring, Mrs. Lyons can effectively manage her hypertension, obesity, and hyperlipidemia, reducing her risk of cardiovascular complications and improving her overall health.

 

 

 

 

 

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