HYPERTENSION

LEARNING TASK
Case 1
A 42-year-old male presents to your office as a new patient. He has been in good health and has not seen a
physician in many years. While attending a local health fair recently, the patient was told that he had high
blood pressure, and he was advised to seek medical help. He seeks your advice about hypertension. His
blood pressure is 145/95 mm Hg.
1. What is the recommended initial diagnostic workup for this patient?
2. What is the management of this patient?
Case 2
A 51-year-old male recently relocated to the area and presents to your office as a new patient. He denies
having any history of medical problems. He made very infrequent visits to a primary care provider where
he previously lived. He is on no medicines and denies having any significant family medical history. He is
a current smoker with a 40 pack-year smoking history. His blood pressure is 170/95 mm Hg, and a fourth
heart sound is present. His physical examination is otherwise unremarkable.
1. What is the recommended initial diagnostic workup for this patient?
2. What is the management of this patient?
Case 3
A 55-year-old man presents to establish primary care. His medical history is significant only for 40
packyears of smoking. He drinks four beers a night. He is minimally physically active. On physical
examination, the patients blood pressure is 158/98 mm Hg, and he is moderately obese (body mass index,
27); the rest of his examination is normal. His laboratory examination, including a chem 7, CBC, TSH,
and urinalysis, is normal, as is his electrocardiogram. Repeated blood pressure measurements over the
next month are similar to the values first obtained.
1. With respect to this patients blood pressure, what therapeutic option should be offered to
this patient now?
2. What should be the first-line pharmacologic therapy for this patient?

Case 4

A 72-year-old woman comes to see you to establish care, after her previous physician retired. Her medical
history is significant for diet-controlled diabetes and a myocardial infarction. She is taking aspirin,
simvastatin, and amlodipine. On examination, her blood pressure is 170/95 mm Hg. She has an S4 gallop
and pretibial edema.
1. What should be the target blood pressure in the long term for this patient?
2. What other hypertension drugs that can be added in these patient?

SELF ASSESMENT
1.
2.

What are the goals of hypertension treatment?

Is systolic or diastolic blood pressure more powerful as a predictor of cardiovascular

complications of hypertension?
3. What is secondary hypertension?
4. What is the recommended initial diagnostic workup for a hypertensive patient?
5. How many classes of antihypertensive medication?
6. How the strategy for starting therapy of hypertension?