Help me draft a Hospital Plan (HP)

From the Guidelines

To draft a comprehensive History and Physical (HP) document for a patient with cardiovascular disease, it is essential to include a detailed medical history, physical examination, and assessment of the patient's current status, as outlined in the 2007 update from the American Heart Association 1. The HP document should start with the patient's identifying information and their main reason for seeking care. In the History of Present Illness, detail the chronology of symptoms using the OLDCARTS framework (Onset, Location, Duration, Characteristics, Aggravating/Alleviating factors, Related symptoms, Timing, Severity). Some key points to include are:

• Medical History: Review current and prior cardiovascular medical and surgical diagnoses and procedures, comorbidities, symptoms of cardiovascular disease, medications, and date of most recent influenza vaccination.
• Physical Examination: Assess cardiopulmonary systems, post-cardiovascular procedure wound sites, orthopedic and neuromuscular status, and cognitive function.
• Testing: Obtain resting 12-lead ECG and assess patient’s perceived health-related quality of life or health status. The physical exam should be comprehensive but focused on relevant systems. Conclude with your assessment of the patient's condition and a detailed treatment plan, including documentation of patient assessment information, development of a patient treatment plan, and communication of the treatment and follow-up plans with the patient and primary healthcare provider, as recommended by the 2011 ACCF/AHA focused update 1. This structured approach ensures you capture all essential clinical information while maintaining a logical flow that other healthcare providers can easily follow. Remember to use objective language and include vital signs and pertinent positive and negative findings. The treatment plan should be tailored to the individual patient's needs and circumstances, including the use of medications such as aspirin, clopidogrel, β-blockers, lipid-lowering agents, and ACE inhibitors or angiotensin receptor blockers, as well as lifestyle modifications and cardiac rehabilitation. Enrollment in a cardiac rehabilitation program after discharge can enhance patient education and compliance with the medical regimen 1. Telephone follow-up can serve to reinforce in-hospital instruction, provide reassurance, and answer the patient's questions, and should be considered as part of the follow-up plan 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Hypertension Treatment Overview

• Hypertension is a significant health problem, affecting approximately 30% of the US population, with only 36.8% having their blood pressure controlled to recommended levels 2.
• The risk of diabetes, renal disease, stroke, and cardiovascular disease is increased for those with uncontrolled hypertension 2.

Treatment Options

• Therapeutic options for the treatment of hypertension include several major classes of drugs: diuretics, β-adrenoceptor antagonists (β-blockers), ACE inhibitors, angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]), renin inhibitors, calcium channel blockers, and central sympatholytics, alone or in combination 2.
• Guidelines recommend thiazide diuretics as preferred first-line monotherapy, but only 50% of patients will respond adequately to this therapy, and the rest will require two or more antihypertensive agents to achieve blood pressure goals 2.

Combination Therapy

• Clinical evidence demonstrates that some drugs have advantages when used in combination rather than as monotherapy, such as ARBs in combination with amlodipine for the treatment of hypertension 2.
• The combination of an angiotensin II receptor blocker, a calcium channel blocker, and a thiazide diuretic is a rational combination for triple fixed-dose combination therapy, with significant blood pressure reductions observed with this regimen compared to dual combinations 3.
• ARB-based combination therapy is recommended for patients with diabetic and non-diabetic renal impairment due to superior renoprotective effects compared to other antihypertensive classes 4.

Specific Combinations

• The combination of beta-blockers and ACE inhibitors is of special interest due to their complementary actions on the sympathetic nervous system and renin-angiotensin-aldosterone system, with supporting evidence for their use in various cardiovascular indications 5.
• Diuretics and calcium-blocking drugs are more effective in elderly patients at lowering systolic blood pressure, while beta-blockers are relatively ineffective and have more side effects 6.