Unit 2: Management of the Patient with Cardiovascular Disease
Management of the Patient with Cardiovascular Disease
Diagnosis
The 58-year-old African American man has high blood pressure that is not under control. His blood pressure is 166/94 mmHg, despite taking 5 mg of amlodipine daily. His lipid profile—total cholesterol 210 mg/dL and LDL 142 mg/dL—shows that he has hyperlipidemia, which raises his risk of heart disease. The slight swelling in both lower limbs is likely a mild side effect of calcium channel blockers. So, Stage 2 hypertension and hyperlipidemia are the primary diagnoses (Borghi et al., 2022). To lower long-term cardiovascular morbidity and death, both of these conditions need more intensive care.
Medication Management and Rationale
The patient’s current blood pressure medication regimen is insufficient to help him reach his goal blood pressure levels (<130/80 mmHg). African American people with Stage 2 hypertension should get a combination of drugs, mainly a thiazide-type diuretic and a calcium channel blocker, as their first choice (Zhai et al., 2023). Adding a thiazide diuretic to the amlodipine he is already taking will help control his blood pressure through mechanisms that are different but related. Hydrochlorothiazide (HCTZ) 25 mg taken by mouth once a day is fine, but electrolyte abnormalities should be closely monitored. Because his LDL is high, he needs to start taking statins to help avoid atherosclerotic cardiovascular disease (ASCVD). Atorvastatin 20 mg, taken by mouth once daily before bed, can effectively lower LDL and total cholesterol while improving the lipid profile as a whole. Famotidine should be kept up for GERD because it does not interact with any other drugs in the suggested regimen.
Prescription Plan
- Amlodipine 5 mg PO once daily (continue current dose).
- Hydrochlorothiazide 25 mg PO once daily in the morning.
- Atorvastatin 20 mg PO once daily at bedtime.
- Famotidine 40 mg PO once daily in the evening.
- Encourage daily blood pressure self-monitoring and recording (Borghi et al., 2022).
Patient Education
The patient should be taught to stick to his new drug regimen and be aware of any possible side effects, like muscle pain from statins or more urination from HCTZ. The patient should be told to stick to the DASH diet (low in sodium), eat more fruits, veggies, and whole grains, and drink less alcohol (Paranjpe et al., 2022). To achieve optimal blood pressure and lipid control, he needs to maintain a healthy weight and engage in at least 150 minutes of moderate exercise each week. The patient should also be told how important it is to have regular lipid and blood pressure checks, and how controlling these factors can help him avoid heart disease and stroke in the long run.
Follow-Up and Referral Plan
The patient should return in 4 weeks for a follow-up visit to assess how blood pressure is responding and how well the new medicines are working. In that case, a basic metabolic panel should be ordered to assess kidney function and electrolyte levels, given thiazide use (Borghi et al., 2022). To see how well statin treatment is working, a lipid panel should be done again in six to eight weeks. For personalized eating advice, he should be referred to a dietitian. If combination treatment does not lower blood pressure, the patient may need to see a cardiologist for further testing and possible medication changes.
References
Borghi, C., Fogacci, F., Agnoletti, D., & Cicero, A. F. G. (2022). Hypertension and dyslipidemia combined therapeutic approaches. High Blood Pressure & Cardiovascular Prevention, 29(3), 221–230. https://doi.org/10.1007/s40292-022-00507-8
Paranjpe, R., Chen, H., Johnson, M. L., Birtcher, K., Serna, O., & Abughosh, S. (2022). Adherence to concomitant diabetes, hypertension, and hyperlipidemia treatments among older patients. Journal of the American Pharmacists Association, 62(4), 1351–1358. https://doi.org/10.1016/j.japh.2022.03.011
Zhai, Z., Yang, Y., Lin, G., Lin, W., Wu, J., Liu, X., Zhang, S., Zhou, Q., Liu, H., & Hao, G. (2023). The hypertension and hyperlipidemia status among type 2 diabetic patients in the community and influencing factors analysis of glycemic control. Diabetology & Metabolic Syndrome, 15(1). https://doi.org/10.1186/s13098-023-01013-0
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Instructions
It is anticipated that the initial discussion post should be in the range of 250-300 words. Response posts to peers have no minimum word requirement but must demonstrate topic knowledge and scholarly engagement with peers. Substantive content is imperative for all posts. All discussion prompt elements for the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments unless specified in the instructions. All posts should be supported by a minimum of one scholarly resource, ideally within the last 5 years. Journals and websites must be cited appropriately. Citations and references must adhere to APA format.
2.
Initial Response
Instructions:
Scenario
You are seeing a 58-year-old African-American male who presents to the clinic for a routine follow-up.
- The patient has a past medical history of hypertension, and GERD. He is currently taking amlodipine 5mg daily and famotidine 40mg daily.
- He denies smoking or nicotine use, drinks alcohol about once a month, and has a cup of coffee once a day
- He had lab work complete prior to his visit showing: Total Cholesterol: 210; HDL: 44 Triglycerides 120; LDL 142
- His vitals are as follows: BP: 166/94, HR: 84; RR: 18; O2: 96% on room air, and T: 98.4; Height: 70 inches, Weight: 220 pounds
- Upon examination today his lung sounds are clear and heart rhythm is regular. He has just a trace of edema to both lower extremities, but skin is pink and dry. No other abnormalities are noticed on exam.
Discussion Prompt
Please develop a discussion post that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion post:
- Provide your diagnosis.
- Discuss how you would manage the patient’s current medication regimen and provide a rationale supported by scholarly reference for your treatment plan.
- Include your specific prescription(s) for the patient. (This must include the medication name, dose, route, and frequency as well as any special instructions that apply as you would include when writing a prescription).
- Describe the patient education you would provide in relation to your treatment plan.
- Provide your plan for follow-up and/or referral (if indicated)
Please be sure to validate your opinions and ideas with citations and references in APA format.