From the Guidelines
I strongly recommend initiating the patient's prescribed antihypertensive medication immediately during the visit to address her elevated blood pressure, as prompt treatment is crucial for patients with stage 2 hypertension and BP ≥160/100 mm Hg, as suggested by the 2017 American College of Cardiology/American Heart Association hypertension guideline 1. Given the patient's history of hypertension, rheumatoid arthritis, and anxiety, it is essential to coordinate care with her rheumatologist, Dr. Warmaouth. The patient's current blood pressure readings should be documented and compared with target goals, considering her age and comorbidities.
- Review her current antihypertensive regimen, considering medications like ACE inhibitors, ARBs, calcium channel blockers, or diuretics that may be appropriate for her age and comorbidities.
- Discuss potential barriers to medication adherence, such as forgetfulness, side effects, or cost concerns, and implement strategies like pill organizers, medication reminders, or simplified dosing schedules.
- Recommend lifestyle modifications including reduced sodium intake, regular physical activity, stress management techniques, and limited alcohol consumption, as these can help lower blood pressure and improve overall health.
- Home blood pressure monitoring should be encouraged with a log to track readings, allowing for more accurate assessment of blood pressure control and medication effectiveness.
- Schedule a follow-up appointment in 2-4 weeks to reassess blood pressure control and medication effectiveness, as suggested by the guideline 1, to ensure the patient's blood pressure is well-controlled and to make any necessary adjustments to her treatment plan.
From the FDA Drug Label
Lisinopril tablets USP are indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure. The patient's current concern is her blood pressure, and she has not taken her medication yet today.
- Hypertension treatment: The patient is indicated for lisinopril, as she has a history of HTN.
- Current medication status: The patient has not taken her medication today, which may affect her current blood pressure reading. The patient should take her medication as prescribed by her doctor, in this case, Dr. Warmaouth, the Rheumatologist on her case 2.
From the Research
Patient's Current Condition
The patient is a 41-year-old female with a past medical history (PMH) of Rheumatoid Arthritis (RA), Hypertension (HTN), and Anxiety. She has been established with a specialist, Dr. Warmaouth, a Rheumatologist, and is currently in the clinic for an evaluation of her blood pressure (BP) before taking her medication for the day.
Medication and Treatment
- The patient's BP is being evaluated, but she has not taken her medication yet today.
- Studies have shown that calcium channel blockers (CCBs) are effective in lowering blood pressure and reducing cardiovascular morbidity and mortality in hypertensive patients 3, 4.
- Combination therapy with an ACE inhibitor and a CCB has been shown to be an optimal combination for the treatment of hypertension, providing an additional antihypertensive effect and minimizing the probability of adverse effects related to the dose of antihypertensive 5, 6.
- Fixed combinations of ACE inhibitors and CCBs, such as perindopril and amlodipine, have been shown to be effective in lowering blood pressure and reducing cardiovascular risk factors 5, 6.
Management of Hypertension
- The management of primary hypertension in adults involves diagnosis using clinic, ambulatory, and home blood pressure monitoring, risk factors, BP targets, lifestyle advice, drug treatment, and patient education 7.
- The National Institute for Health and Care Excellence guidelines provide recommendations for the diagnosis, assessment, and management of hypertension 7.
- Lifestyle modifications, such as diet and exercise, are also important in managing hypertension, in addition to medication therapy 7.