What is the diagnosis for a 48-year-old patient presenting with intermittent, occasional throbbing pain in the right hand after a fall onto an outstretched hand two weeks ago, with a pain level of 0/10 at rest and 7/10 with activity, and newly diagnosed Hypertension (HTN) for which Lisinopril (Lisinopril) will be started?

From the Guidelines

The patient's history of present illness (HPI) should focus on both the resolving hand injury and the newly identified hypertension, with an emphasis on initiating lisinopril for blood pressure management as per the latest guidelines 1. The patient is a 48-year-old individual presenting for a general check-up with a complaint of right hand pain following a fall two weeks ago when they landed on an outstretched hand. The patient reports intermittent throbbing pain that ranges from 0/10 at rest to 7/10 at its worst, though it has improved over the past week. The patient denies any changes in hand function or weight loss. Regarding hypertension, there appears to be a discrepancy as the patient denies having hypertension despite elevated blood pressure readings during the last two office visits.

• The patient's blood pressure readings indicate stage 1 hypertension, according to the classification provided in the JNC 7 report 1.
• The latest guidelines from the U.S. Department of Veterans Affairs/U.S. Department of Defense clinical practice guideline recommend a definition of hypertension as 130/80 mm Hg 1.
• The patient's hand injury appears to be resolving without complications, but continued monitoring is warranted.
• The focus of this visit includes addressing both the resolving hand injury and the newly identified hypertension requiring medication intervention, with lisinopril being a suitable initial treatment option as per the guidelines 1. The initiation of lisinopril is a crucial step in managing the patient's hypertension, and regular follow-up is necessary to monitor the patient's response to treatment and adjust the management plan as needed 1.

From the Research

History of Present Illness (HPI)

The patient is a 48-year-old individual who presented to the clinic for a general check-up. The patient reported a history of falling two weeks ago, landing on an outstretched hand, and experiencing intermittent, occasional throbbing pain. The pain level was reported as 0/10 at rest and 7/10 with activity. The patient denied any recent changes or weight loss.

Past Medical History

The patient has a history of hypertension, which was previously undiagnosed. The patient's blood pressure has been elevated during the last two office visits, and the patient will be started on lisinopril.

Relevant Studies

• A study published in 2017 found that antihypertensive medications, including diuretics, renin-angiotensin-aldosterone system inhibitors, beta-blockers, and calcium channel blockers, may impact bone metabolism and architecture, potentially increasing the risk of fractures 2.
• Another study published in 2012 found that initiating antihypertensive therapy in elderly patients was associated with an increased risk of hip fractures, particularly during the first 45 days of treatment 3.
• A randomized clinical trial published in 2017 found that thiazide-type diuretic therapy was associated with a reduced risk of hip and pelvic fractures compared to other antihypertensive medications, including lisinopril 4.
• A case-control study published in 2009 found that hypertension was a significant risk factor for fractures, particularly in the short-term and long-term perspectives 5.

Key Points

• The patient's history of falling and experiencing pain in the hand may be related to the initiation of antihypertensive therapy, as some studies suggest an increased risk of falls and fractures associated with these medications 2, 3.
• The patient's diagnosis of hypertension and initiation of lisinopril therapy may also be relevant to the patient's risk of fractures, as some studies suggest that certain antihypertensive medications may impact bone health 4, 5.