Hypertension Case Study Essay
Nursing Pharmacology: Hypertension Case Study
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Introduction
Hypertension accounts for the greatest global disease burden especially in low and middle income nations. In well-developed countries, its prevalence is high among minority groups due to structural and systemic inequalities (Hernandez-Vila, 2015). In this paper, the author analyzes the case study of D.G., a 54-year-old African American with hypertension. In this analysis, the author evaluates the appropriateness of the use of hypertension clinical guidelines in the management of D.G., the initial treatment plan, and provides additional evidence-based constructive feedback. For the effective management of hypertension, clinicians utilize the most recent evidence-based clinical guidelines in clinical decision-making. Guidelines promote consistency of care and improve health outcomes Hypertension Case Study Essay.
Use of Clinical Guidelines
The case study utilizes the JNC 8 guidelines to determine the most appropriate approaches to managing the patient’s hypertension. This clinical guideline is commendable since it has a high reliability. The researchers based the recommendations on the findings from RCTs and expert opinions to evaluate the most appropriate treatment for blood pressure (Armstrong, 2014). The RCTs used large population samples that promote the generalization of findings to larger populations. The findings of the guideline are also valid since the population samples only comprised of patients from different ethnicities diagnosed with hypertension initiated on different hypertensives with different BP goals (Armstrong, 2014) Hypertension Case Study Essay. Apart from the researchers sharing the transparent and systematic process of developing the guidelines, they were experts and specialists in blood-pressure related issues and had an advanced medical background level.
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Initial Treatment Plan
The most recent clinical guidelines for the management of hypertension recommend the initiation of a thiazide diuretic or a calcium channel blocker (CCB) as the first line management for hypertension in adults aged <60 years with no chronic kidney disease (CKD) or diabetes (DM)). Examples of thiazide diuretics appropriate in this category include hydrochlorothiazide and chlorthalidone, at a dosage of 12.5-25mg daily. Examples of CCBs include amlodipine at a dosage of 5-10mg daily, commonly referred to as norvasc (Armstrong, 2014). Alongside pharmacological management, clinicians should reinforce medication adherence and lifestyle modification for the attainment of blood pressure goals. Lifestyle modifications in this category include smoking cessation, dietary modification, and embracing physical activity. Dietary modification includes maintaining a DASH diet, decreasing sodium intake to 2,400mg/day and engaging in moderate-intense vigorous activity three to four days weekly each session lasting 40 minutes on average (Hernandez-Vila, 2015).
In this case study, the clinician prescribed amlodipine (norvasc) 5 mg to D.G and made several recommendations for her lifestyle modification. Therefore, the prescribed pharmacological and non-pharmacological approaches meet the guideline recommendations. However, the clinician’s requirement for D.G to return for follow-up in 4 months does not meet the guideline recommendations. The JNC8 guidelines recommend that newly diagnosed hypertensive patients return for follow-up in 2-4 weeks (Armstrong, 2014).
Evidence-Based Addition
This case study provides insights on the role of providers in the management of hypertension. D.G failed to return to the clinic for follow-up as scheduled. Evidence from currently existing studies highlight that African Americans are a highly vulnerable group to non-adherence for the control of hypertension and clinicians should implement interventions to decrease the negative impact of their vulnerability. Apart from the suggested strategies to improve adherence, Ephraim et al., (2014) recommend the incorporation of community health workers (CHWs) in management through encouragement where they act as connective support. Community Health workers can enhance the follow up for hypertension by acting as a link between the clinic and patients, and by conducting home visits Hypertension Case Study Essay.
References
Armstrong, C. (2014). JNC8 guidelines for the management of hypertension in adults. American family physician, 90(7), 503-504.
Ephraim, P. L., Hill-Briggs, F., Roter, D. L., Bone, L. R., Wolff, J. L., Lewis-Boyer, L., Levine, D. M., Aboumatar, H. J., Cooper, L. A., Fitzpatrick, S. J., Gudzune, K. A., Albert, M. C., Monroe, D., Simmons, M., Hickman, D., Purnell, L., Fisher, A., Matens, R., Noronha, G. J., Fagan, P. J., … Boulware, L. E. (2014). Improving urban African Americans’ blood pressure control through multi-level interventions in the Achieving Blood Pressure Control Together (ACT) study: a randomized clinical trial. Contemporary clinical trials, 38(2), 370–382. https://doi.org/10.1016/j.cct.2014.06.009
Hernandez-Vila E. (2015). A review of the JNC 8 Blood Pressure Guideline. Texas Heart Institute journal, 42(3), 226–228. https://doi.org/10.14503/THIJ-15-5067
Kataria Golestaneh, A., Clarke, J. M., Appelbaum, N., Gonzalvez, C. R., Jose, A. P., Philip, R., & Beaney, T. (2021). The factors influencing clinician use of hypertension guidelines in different resource settings: a qualitative study investigating clinicians’ perspectives and experiences. BMC Health Services Research, 21(1), 1-12 Hypertension Case Study Essay.