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Case Study Of A Patient With High Blood Pressure

Question

Mrs B. Luv is a 70 year old female of average height. She weighs 85 kg. She has recently been found to have a blood pressure of 159/98 mmHg and is pre-diabetic.  Mrs Luv also has some renal impairment.  Her nurse practitioner has advised Mrs Luv to make some lifestyle changes to reduce her blood pressure and prevent diabetes.

(i)    Briefly describe the lifestyle changes that would both reduce blood pressure and prevent diabetes?

Unfortunately, Mrs Luv only makes a minor attempt to decrease her blood pressure and risk of developing diabetes with lifestyle modification.  Several successive visits over six months to the nurse practitioner have seen little reduction in blood pressure.  The nurse practitioner believes it is in Mrs Luv’s best interest to start antihypertensive treatment. The GP prescribed hydrochlorothiazide with amiloride for Mrs Luv.

(ii)    What is the mechanism of action of hydrochlorothiazide?
(iii)    What is the mechanism of action of amiloride?
(iv)    Why are they used together?
(v)    Is this an appropriate combination to give to Mrs Luv

Which of the following could be prescribed to further lower or as an alternative to hydrochlorothiazide with amiloride to lower Mrs Luv’s blood pressure?

A: Fosinopril

(iv) What is the mechanism of action of fosinopril? Is fosinopril available in combination with another drug for the treatment of hypertension?

B: Felodipine

(vi)    What is the mechanism of action of felodipine? What are the side effects of this treatment, and what action causes most of these side effects?
C: Valisartan

(vii)      What is the mechanism of action of valsartan? How is valsartan different from a pril?  What dose of valsartan will Mrs Luv be started on, and why?
(viii)    
D: Isosorbide mononitrate

(ix)    What are the mechanism of action/s of isosorbide mononitrate? Which group of drugs should not be used with the nitrates, and why?
(x)    Which of these four drugs is the best option for Mrs Luv’s hypertension? Explain why you have chosen one over the others.

Later on in life, Mrs Luv develops typical angina in addition to hypertension.  

(xi) Would fosinopril, felodipine or isosorbide monitrate be useful in preventing angina, and if so, how would they prevent angina?


Summary

The question belongs to Nursing and it discusses about a case study of a 70 year old female patient with high blood pressure.

Total Word Count 1119

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