Please respond to at least 2 of your peerâ€™s posts. To ensure that your responses are substantive, use at least two of these prompts:
- Do you agree with your peersâ€™ assessment?
- Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
- Share your thoughts on how you support their opinion and explain why.
- Present new references that support your opinions.
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the studentâ€™s position.
Please be sure to validate your opinions and ideas with citations and references in APA format.
1- Dhara Patel
What is your initial choice for an antihypertensive medication for this patient? (Support your treatment plan with a discussion of the evidence-based guideline you utilized)
The JNC8 evidence-based guidelines for treating high blood pressure in adults recommended ACE inhibitors as one of four drug classes recommended for initial therapy for adults with elevated blood pressure. I believe this patient can benefit from Perindopril as the initial choice. Evidence has found that ACE inhibitor has been primarily used in the treatment of HTN along with calcium channel blockers and have helped to reduce the morbidity and mortality secondary to cardiovascular disease (Henderson et al., 2003). Perindopril effectively helps to lower the mean arterial blood pressure as well as systolic and diastolic blood pressure in a patient (Herman et al., 2023). This medication also helps with less fluid along with improving insulin sensitivity which can lead to weight loss and a decrease in the risk of developing obesity-related health conditions (Mantracare, 2023). This medication also works by stimulating the sympathetic nervous system, which helps to increase metabolism (Mantracare, 2023). This can lead to more calories being burned, which can lead to weight loss (Mantracare, 2023). When combined with healthy lifestyle changes, ACE inhibitors can be an effective tool in weight loss efforts (Mantracare, 2023). Some of the most common side effects of ACE inhibitors include dry cough (most common), dizziness, headache, feeling fatigued, weakness, angioedema (rare but can be severe), jaundice, and allergic reactions (Herman et al., 2023). This patient can be started on Perindopril as it is associated with a relatively low incidence of cough and has extensive evidence supporting its cardiovascular benefits and tolerability (Pinto et al., 2020). I would start this patient on Perindopril 4mg; 1 tablet by mouth daily. I would also recommend this patient take the medication around the same time each day and take it daily without missing any dosage and not take more or less of it than what is prescribed to her for better medication compliance.
Which therapeutic lifestyle change is a priority in helping J.S. achieve blood pressure control?
The lifestyle changes that J.S. would need to achieve better blood pressure control would need her to quit smoking, lose extra weight, start exercising daily, eat a healthy diet, reducing salt intake in her diet. The priority lifestyle change that she needs is to quit smoking. I would recommend that it is never too late to quit smoking. I would inform her that cigarette smoking is a major cause of the cardiovascular disease (CVD) and is responsible for about 1 in every 4 U.S. deaths from CVD (Centers for Disease Control and Prevention, 2021). Research has shown that smoking increases the risk of CVD including atherosclerosis, coronary heart disease, myocardial infarction, sudden cardiac death, stroke, peripheral arterial disease, and abdominal aortic aneurysm. Quitting smoking will prevent her chances of these cardiovascular diseases and will also reduce her risk of sudden cardiac death and atrial fibrillation (Centers for Disease Control and Prevention, 2021). I would also inform her to limit fat and sodium intake and maintain a healthy weight by exercising. The current physical activity guidelines for HTN include that adults should perform 150 to 300 minutes per week of moderate-intensity or 75 to 150 minutes per week of vigorous-intensity aerobic exercise, along with performing muscle-strengthening activities at least 2 days per week (Rego et al., 2019).
Which of the following diagnostic tests would you order for J.S. to establish a baseline before starting an anti-hypertensive?
Some of the diagnostic tests order to establish a baseline before the treatment would include 12 lead ECG to assess for cardiac rate/rhythm and for any left ventricular hypertrophy, eye exam for assess for retinopathy (as warranted), blood workup including complete blood count, ESR, creatinine, eGFR, electrolytes, HbA1c, thyroid profile, blood cholesterol levels, and serum uric acid, Urine albumin to creatinine ratio along with urinalysis to look for any kidney damage as a result of untreated hypertension (Iqbal & Jamal, 2022).
- What is your initial choice for an antihypertensive medication in this patient? (Support your treatment plan with a discussion of the evidence-based guideline you utilized)
With antihypertensives it is important to keep in mind that some medications negatively affect those of color and should be avoided when possible. This patient identifies as Hispanic and therefore falls under a person of color (Starr & Freeland, 2023). The preferred treatment for a person of color includes thiazides and calcium channel blockers (Rodriguez et al., 2016). The initial treatment that I would start for this patient would be hydrochlorothiazide 25mg PO daily and amlodipine 5mg daily due to the patients current recorded blood pressure (Rodriguez et al., 2016).
- Which therapeutic lifestyle change is a priority in helping J.S. achieve blood pressure control?
Lifestyle changes for this patient would include dietary changes. This patient would more than likely benefit from the Mediterranean diet. The Mediterranean diet is a healthy cardiac diet and can also promote healthy weight loss (Mayo Clinic, 2021). Another important lifestyle change that would benefit this patient is cessation of smoking. Smoking greatly increases the risk of cardiovascular complications and incidents. Some of the other effects of smoking include increased inflammatory responses, and changes in blood viscosity. Additionally, exercise and limiting alcohol consumption, proper sleep, and stress management can assist the patient with blood pressure control and overall health and well-being. There are studies that indicate Hispanics are less likely to exercise to control any chronic illness (Rodriguez et al., 2016).
- Which of the following diagnostic tests would you order for J.S. to establish a baseline before starting an anti-hypertensive?
I would do an EKG on this patient to see if the patient persistent hypertension has caused other issues that may be noted with an EKG. Laboratory test that I would perform would include a CMP, kidney function test, lipid profile CBC, glucose testing and TSH. These results could determine what type of blood pressure medication would be most effective for this patient and what medications may cause more harm. The lipid profile for this patient once obtained could be a key indicator in promoting cardiovascular health. Hispanics in general according to (Rodriguez et al., 2016) have a higher LDL cholesterol level. I also think the use of the ASCVD estimator in this patient would be important if the blood glucose levels or lipids panel come back elevated (American College of Cardiology, 2021).