Pharmacology Hypertension Essay
The 64-year-old African American female patient in the case study provided presented with uncontrolled hypertension. Lifestyle modifications and a diuretic were prescribed as initial treatment. According to the American Society of Hypertension and the International Society of Hypertension (ASH/ISH) treatment guidelines for hypertension, a thiazide diuretic such as hydrochlorothiazide (HCTZ) is considered the first-line drug for the management of uncomplicated stage I and II hypertension among patients from African ancestry. Hripcsak et al. (2020) report that HCTZ has displayed great effectiveness in the management of hypertension with reduced side effects at lower doses.
HCTZ acts by inhibiting the sodiumchloride co-transporter in the distal convoluted tubule. This leads to the excretion of more sodium and fluids hence lowering the blood pressure (Manolis & Kallistratos, 2019).Some of the most common side effects of the drug include gastric irritations, nausea/vomiting, jaundice, fatigue, diarrhea/constipation, and abdominal cramping among others. Patients taking this drug must monitor their electrolytes levels regularly. HCTZ can also potentiate the precipitation of hepatic coma among patients with impaired liver function.
When working at the primary care clinic, I encountered a 45-year-old African American female who presented with elevated blood pressure despite initial treatment with diet and exercise. She had been diagnosed with stage 1 hypertension. Upon evaluation, the patient wasrecommended to take hydrochlorothiazide 25 mg once a day as an adjunct to diet and exercise and advised to report for follow-up evaluation after 1 week. She came back the following week looking energetic, claiming that her blood pressure is well controlled, and she has not experienced any side effects so far. This is an example of a positive outcome associated with the use of HCTZ in the management of hypertension.
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Hripcsak, G., Suchard, M. A., Shea, S., Chen, R., You, S. C., Pratt, N., … & Schuemie, M. J. (2020). Comparison of cardiovascular and safety outcomes of chlorthalidone vs hydrochlorothiazide to treat hypertension. JAMA internal medicine, 180(4), 542-551. https://doi.org/10.1001/jamainternmed.2019.7454
Manolis, A. J., & Kallistratos, M. S. (2019). Recently published hypertension guidelines: A critical approach. European Journal of Internal Medicine, 63, 1–2. https://doi.org/10.1016/j.ejim.2019.04.005
Lorraine is a 64-year-old African American female who has been monitoring her blood pressure at home. She brings a log of home readings with the following ranges: 150-222/102-88. Her blood pressure in the office today is 160/92. She has her BP monitor with her and the reading on the monitor is similar to today’s office reading. She states that she has swelling in both ankles at night, but the swelling usually resolves overnight. She wears compression hose at work as she is on her feet for most of her 10-hour shift. She has no comorbid conditions and no known allergies at present . Her mother and sister have hypertension and encouraged Lorraine to seek care.
Initial treatment of an African American patient will be lifestyle changes and a diuretic. Choose a diuretic and discuss the mechanism of action, monitoring, and side effects. In addition, share a time when the use of this medication resulted in a positive or negative outcome in a patient for whom you were caring. Discuss evidence and treatment guidelines to determine appropriate therapeutic options for this patient. Include the name of the medication in the subject line so that the medications can be followed.