Case Overview
Jerry is a 62-year-old white male. Jerry is here for a follow-up visit after an elevated blood pressure measurement in the office two weeks ago of 160/90. At the time of the last visit, Jerry denied vision changes, headaches, weakness, dizziness, chest pain, shortness of breath, and edema. Today, he denies headaches, vision changes, or dizziness. Jerry was asked to keep a daily BP log and return to the office to review his blood pressure readings. He was asked to take his BP every morning an hour after waking and in the evening prior to going to bed.
Blood Pressure Log
| Day | AM Reading | PM Reading |
|---|---|---|
| Monday | 138/86 | 144/92 |
| Tuesday | 134/82 | 142/92 |
| Wednesday | 135/84 | 148/96 |
| Thursday | 132/82 | 140/90 |
| Friday | 132/78 | 146/90 |
| Saturday | 136/84 | 139/88 |
| Sunday | 132/75 | 136/78 |
| Monday | 128/82 | 134/86 |
| Tuesday | 130/80 | 152/90 |
| Wednesday | 137/85 | 146/94 |
| Thursday | 140/88 | 154/92 |
| Friday | 136/78 | 146/98 |
| Saturday | 142/80 | 141/91 |
| Sunday | 136/84 | 148/96 |
PMH: Type 2 Diabetes, Obesity, osteoarthritis
PSH: Rotator cuff repair (R)
MEDS: Metformin 500mg PO Twice daily; Ibuprofen 200-400 mg PO q 6 hours prn.
SOCIAL Hx: Married, lives with spouse. Quit smoking tobacco products 10 years ago. 30 pack-year smoking history. One to two 2-ounce whiskeys nightly for the last 25 years.
Occupation: Retired in the last 3 months, worked as a general contractor.
ROS:
General: 55-pound weight gain over the last ten years, with a 20-pound gain in the last year.
HEENT: see HPI
RESP: Denies shortness of breath, cough, or pain with inspiration.
CV: Denies chest pain, palpitations, or peripheral edema.
GI: Denies heartburn, nausea, vomiting, diarrhea, or abdominal pain.
Physical Exam:
Temp: 98.7 F; Pulse: 86 bpm; BP: 146/92 mm Hg; Resp: 12; Oxygen Saturation: 98% room air
HEENT Exam: Face is flushed. No thyroid nodules or enlargement.
RESP: Lung sounds are vesicular. No adventitious sounds.
CV: S1, S2, No gallop or murmur. Carotids 2+ bilaterally, no bruits present. PMI is displaced to 6th ICS midaxillary line with heaving in the left lateral decubitus position.
Instructions
Compose Initial Response
Compose an evidence-based response to address the following:
- What are the stages of hypertension? How would you stage Jerry's hypertension?
- What other history information would you want to review?
- What are the recommendations for both non-pharmacologic and pharmacologic treatments for this stage of hypertension?
- Would you start Jerry on medication? If yes, which med, dose, and frequency, and why? If not prescribing medication, then what is the plan and objectives for Jerry?
Use the latest hypertension clinical practice guidelines and any other evidence-based guidelines you consider.
Your response should be 250-400 words and include sources in APA formatLinks to an external site..
Compose Response to Peer
Read the responses posted in the discussion by other members of the class. Reply to at least one classmate with a recommendation from level 1, 2, or 3 evidence and/or a clinical practice guideline.
Include sources in APA formatLinks to an external site..
Compose Final Post
Considering what you read in your peers' posts, reply to your initial post, addressing the following:
- Do you still agree with your treatment plan?
- What patient education would you provide this patient? What would you tell Jerry to anticipate regarding the plan?
- When would you follow up with Jerry, and what would you review?