Based on Mike’s history and exam, what tests would you consider and why?
His doctor orders a straightforward metabolic panel. On top of that other things to be utilized are the electrocardiogram (EKG) in order to check the heart, along with a measurement of hemoglobin A1C (A1C). this is important because if a hemoglobin test exposes that your hemoglobin level is lesser than normal, it means that Mike may have a low red blood cell count (anemia). Furthermore, there needs to a urinalysis, urine protein / creatinine ratio, aldosterone, and a lipid panel.
What are the different types of hypertension and its pathophysiology.
The pathogenesis of essential hypertension is multifactorial and highly complex (Tong, 2015). Multiple factors moderate the blood pressure (BP) for suitable tissue perfusion and consist of humoral mediators, vascular reactivity, vascular caliber, mingling blood volume, blood vessel elasticity blood viscosity, cardiac output, and neural inspiration (King, 2015). A likely pathogenesis of vital hypertension has been projected wherein multiple factors, as well as genetic tendency, excess dietary salt intake, and adrenergic tone, may interrelate to yield hypertension. Even though genetics appears to donate to vital hypertension, the exact mechanism has not been recognized.
3. What would your treatment goals be for Michael?
1. Decrease cardiovascular and renal morbidity and mortality.
2. Get target BP objectives of <140/90 mmHg or <130/80 mmHg with diabetes or renal disease.
3. Losing weight if it is necessary
4. Eating a healthier diet, as well as the DASH diet (vegetables, eating more fruits, and low fat dairy brands, less saturated and whole fat)
5. Reducing the amount of sodium in your diet to less than 1,500 milligrams a day if since there is some high blood pressure Michael should try to restrict their sodium intake beyond 2,300 milligrams a day.
6. Using the calcium channel blockers which are drugs utilized to lower blood pressure. They work by slowing the movement of calcium into the cells of the heart and blood vessel walls, which makes it easier for the heart to pump and broadens blood vessels
4. What effect would lifestyle modifications have for a patient like Mike?
Lifestyle modifications are essential for Mike. These changes may reduce his blood pressure without the use of prescription medicines. Getting hold of a healthy lifestyle is critical for the deterrence of HBP and a crucial part of keeping it up under control. Think of these changes as a “lifestyle treatment” and make every effort to obey with them.
By accepting a heart-healthy existence, Mike will be able to:
Decrease high blood pressure
Stop or interrupt the growth of HBP
Improve the efficiency of blood pressure medications
Lesser your risk of heart disease, heart attack, kidney disease and stroke
5. What is Mike’s stage of hypertension based on JNC 8 guidelines?
JNC-8 strategies for hypertension treatment stress the position of systolic and diastolic BP control, utilizing age and comorbidities for treatment endorsements. Lifestyle alterations are recommended for all patients with hypertension, nevertheless diet and exercise by themselves aren’t continuously enough to decrease BP to best levels. JNC-8 recommendations emphasis on the chief drive of hypertension treatment — accomplishing and preserving BP in the goal assortment. If routine changes alone aren’t adequate to see BP goals, pharmacologic treatment is suggested, with continuation within 1 month.
6. What are the non-pharmacologic and pharmacologic management of hypertension?
Non-pharmacological management (or lifestyle management) has a vital role in both non-hypertensive and hypertensive persons. In non-hypertensive people, as well as those with pre-hypertension, lifestyle alterations have the budding to stop hypertension and more highly to decrease BP and lower the risk of BP-related clinical problems. In hypertensive people, lifestyle modifications can serve as primary treatment before the start of drug treatment and as an assistant to drug therapy in persons previously on medicine.
Pharmacologic management involve numerous therapeutic agents can be utilized for the pharmacologic management of hypertension. The over-all recommendation recognized by JNC-7 is to pledge a thiazide-kind diuretic originally for stage 1 hypertensives without convincing suggestions for other therapies. Drugs for example inhibitors, and calcium channel blockers (CCBs), and diuretics are all looked at as acceptable alternate therapies in patients with hypertension.
7. What are the different anti-hypertensive medications, mechanism of action and side effects?
Any hypertensive medication can be the cause of side effects, and high blood pressure (HBP) medications are no exclusion. Nevertheless, many individuals do not have side effects from using hypertension drugs, and frequently the side effects are slight. Still, it’s vital to stay knowledgeable and work carefully with your doctor to accomplish any side effects a person can have.
King, C. (2015). Hypertension. Journal of the American College of Cardiology, 13(9), 3-27.
Tong, X. (2015). Hypertension Screening in Children and Adolescents — National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, and Medical Expenditure Panel Survey, United States, 2007-2010. CDC, 23(12).
Treatment of hypertension and the price to pay; adverse events and discontinuation from randomized treatment in clinical trials. (2016). Journal of Hypertension:, 34, 1489-1491.
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