BP Management

Subjective: 40 yo African American Female newly diagnosed stage I hypertension (assume otherwise healthy).  

Office visit 3 months ago has been trialing of lifestyle changes.  BP 134/88 yesterday.   

BP diary is consistently above 130/88.

Fasting labs prior to this visit: Total Cholesterol 190   LDL 140   HDL 40   Triglycerides 250

NKDA       Meds: Atorvastatin 20 mg q hs    

Objective (exam): BP 140/90  HR 80; Ht 6′ 3″   Wt. 250 lbs  BMI: 31.2    assume physical exam unremarkable  

Assessment/Diagnosis:  Hypertension Stage I (failed trial of lifestyle changes)  

What stage of HTN.  What is your next step in BP management?  If you decide to initiate a medication, include class of medication/s and what specific medication/s.  Include dose and frequency.   Any concerns about trial of lifestyle changes?

• Provide rationale for any medication/s additions using HTN guidelines to support evidence-based practice.
• What will your patient medication education include?
• Review lifestyle education with this patient that can affect her BP.

• Per high blood cholesterol guidelines, how will you treat the lipid lab results?  Provide your plan and rationale. 
• Would gemfibrozil be a good choice for elevated triglycerides?  Provide your rationale why or why not. 
• The patient wants to switch her atorvastatin dose to q am, what do you advise her?   Provide your rationale.
• Provide in-text citations and a reference list.  You may use guidelines provided in the module and our text Woo and Robinson.