From the Guidelines
I strongly recommend refilling the patient's blood pressure medication immediately, as she has already missed three days of treatment, to prevent potential rebound hypertension and increased risk of cardiovascular events. Before providing the prescription, I would check her current blood pressure and review her medical history to confirm which specific antihypertensive medication she was previously taking, including the name, dosage, and frequency. The patient should be counseled on the importance of medication adherence, as abrupt discontinuation of antihypertensive therapy can lead to severe consequences, as noted in the 2018 American College of Cardiology/American Heart Association hypertension guideline 1.
The reported fingertip tingling could be related to her blood pressure issues or could be a side effect of her medication, so this symptom should be documented and monitored. Additionally, I would strongly encourage the patient to establish care with a primary care provider for ongoing management of her hypertension and to coordinate care with her neurologist who treats her chronic headaches, as recommended by the American Heart Association 1.
This would help ensure consistent medication management and prevent future lapses in treatment. The patient should also be educated about the importance of having a medication refill plan before running out of pills, such as requesting refills 7-10 days before finishing her current supply. According to the 2018 guideline 1, using a diuretic, such as chlorthalidone or indapamide, and adding a mineralocorticoid receptor antagonist, like spironolactone or eplerenone, can be effective in managing resistant hypertension.
However, given the patient's current situation, the most critical step is to refill her medication and ensure she has a plan in place for ongoing management, which may include referral to a hypertension specialist if her blood pressure remains uncontrolled, as suggested by the American Heart Association 1 and the 2018 guideline 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Patient Evaluation
The patient is a 45-year-old female presenting for an evaluation in urgent care, requesting a refill of her blood pressure medication. She has a history of chronic headaches and sees a neurologist for this condition. She does not have a primary care physician (PCP) and has not taken her blood pressure medication for 3 days due to running out.
Current Symptoms
- Denies dizziness, chest pain, shortness of breath, or recent illness
- Reports intermittent tingling to her fingertips
Blood Pressure Management
According to 2, first-line therapy for hypertension includes lifestyle modification and medication. The patient's request for a refill of her blood pressure medication suggests that she is already being treated for hypertension. The study recommends a target blood pressure of <130/80 mm Hg for adults <65 years and <130 mm Hg for adults ≥65 years.
Treatment Options
- First-line drug therapy for hypertension consists of a thiazide or thiazide-like diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker 2
- The use of ambulatory and home blood pressure monitoring can improve diagnostic accuracy 3
- Lifestyle interventions, such as the Dietary Approaches to Stop Hypertension (DASH) diet, dietary sodium restriction, potassium enrichment, regular exercise, weight loss, and moderation of alcohol consumption, can also be effective in managing hypertension 3
Considerations for Refractory Hypertension
- Resistant hypertension is defined as uncontrolled blood pressure despite the use of ≥3 antihypertensive agents of different classes 4
- Refractory hypertension is defined as uncontrolled blood pressure despite the use of ≥5 antihypertensive agents of different classes 4
- The patient's intermittent tingling to her fingertips may be a symptom of an underlying condition that needs to be evaluated further
Monitoring and Follow-up
- Regular monitoring of blood pressure and electrolyte levels, such as potassium, can help identify any potential issues 5
- The patient should be encouraged to follow up with her neurologist and consider establishing a relationship with a PCP for ongoing care and management of her hypertension and other health conditions.