Case Study Of Hypertension Discussion Paper

Heart disease is the leading cause of death among adults globally, especially in the United States. Of the various heart diseases that contribute to significant adult mortality, coronary heart disease is the leading cause of cardiovascular morbidity and mortality and the leading cause of death in adults globally (Qiu, 2024). Annually, 80% of the adult population in the United States suffers from one of the various cardiovascular diseases, such as coronary artery disease and heart failure (Seth et al., 2024). This data does not include the proportion of the population who suffers from hypertension. Luckily, the incidence and prevalence rates of cardiovascular disease are decreasing in the population compared to the morbidity and mortality rates observed in the 19^th Century (Seth et al., 2024)Case Study Of Hypertension Discussion Paper. The changes in epidemiological statistics in the pattern of distribution and mortality rates from cardiovascular diseases have improved treatment, early diagnosis, and prevention of the disease through lifestyle changes.

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Coronary artery disease, as the name suggests, is a disease that affects the blood vessels that carry the heart’s blood supply. The pathophysiology of the disease stems from atherosclerosis of the vascular intima, resulting in the narrowing of the heart’s blood vessels and subsequent reduced blood flow to the heart muscles (Seth et al., 2024). The atherosclerotic plaque develops from the deposition of fat or lipids in the second layer of the blood vessel wall or on areas of vascular epithelial injury. The fat plaques could grow big to occlude blood flow to the heart or develop clots, which often dislodge and proceed to occlude smaller vessels in the heart’s vasculature (Seth et al., 2024)Case Study Of Hypertension Discussion Paper. The result is reduced blood flow to the heart, which becomes clinically apparent during increased heart demand, such as during exercise. The patient experiences angina pain as a result of cardiac muscle ischemia, classically referred to as myocardial infarction or heart attack.

Various risk factors can predispose an individual to coronary heart disease, and these factors can be easily divided into modifiable and non-modifiable risk factors. Modifiable risk factors are risk factors amenable to change through lifestyle modification. They are related to health behaviours such as smoking cigarettes, physical inactivity, lack of good sleep hygiene or inadequate sleep, poor dietary choices such as fast foods with high sodium and fat components, and obesity (Seth et al., 2024). Other modifiable risk factors include preexisting diseases such as hypertension, diabetes mellitus, hypercholesterolemia, and metabolic syndrome (Seth et al., 2024)Case Study Of Hypertension Discussion Paper. These are best managed using medication to achieve better control of the disease. The non-modifiable risk factors include older age, male gender, and non-Hispanic African American descent. Understanding the risk factors of the disease is crucial since approximately 80% of cardiovascular diseases can be prevented through lifestyle modifications (Qiu, 2024). These lifestyle changes are also crucial in the management of active disease to prevent the risk of occurrence of adverse cardiovascular events such as cardiac arrest. Therefore, in the scenario, the modifiable risk factors include hypertension, hyperlipidemia, chronic renal insufficiency, tobacco smoking, and obesity. The non-modifiable risk factors in the scenario include the age of 65 years, male gender, and African American descent.

As a nurse, I would educate the patient to cease smoking tobacco and take up an active lifestyle to maintain a lower body weight. I encourage patients to enrol in designated exercise programs for patients with cardiovascular diseases to ensure they exercise safely, given their age and heart condition. World Health Organization (WHO) recommends 150 to 300 minutes of moderate-intensity or 75 to 150 minutes of vigorous-intensity physical activity, or their equivalent in aerobic physical activity weekly for adults, in addition to regular muscle-strengthening exercises (Bull et al., 2020)Case Study Of Hypertension Discussion Paper. Additionally, I encourage the patient to assume the DASH diet for hypertensive patients, which is low in sodium and fats and high in vegetables and fruits. The diet would help with blood pressure control and encourage cardiac health in the patient.

Regarding the patient’s chief complaint and high blood pressure reading, the classification of hypertension that the patient is experiencing is hypertension urgency. Hypertension urgency is described as elevated blood pressure without signs of target organ damage. In contrast, hypertension emergency describes a patient’s conditions of markedly elevated blood pressure, often above 180mmHg systolic blood pressure and or elevated diastolic blood pressure of 110 to 120 mmHg with evidence of new or worsening target-organ damage (Bress et al., 2024)Case Study Of Hypertension Discussion Paper. Hypertension urgency and emergency are considered grade 3 hypertension and require immediate management to prevent high risks of major cardiovascular events such as stroke and high rates of mortality. The management of this hypertension crisis is with anti-hypertensive medication, more so vasodilators such as hydralazine and calcium channel blockers such as nifedipine.

The anti-hypertensives highlighted in the case scenario are thiazide diuretics and calcium channel blockers. As the name suggests, the calcium channel blockers block the release of calcium in the vascular smooth muscles, hence preventing their contraction. As a result, the vascular smooth muscles relax, leading to blood vessel dilation and subsequent blood pressure lowering. In contrast, thiazide diuretics help water excretion via the kidneys by blocking sodium reabsorption in the proximal convoluted tubules. The result is the mobilization of oedema and shrinking of the intravascular fluid compartment to reduce both blood pressure and peripheral oedema. Therefore, the patient’s plan of care should include an anti-hypertensive, preferably calcium channel blockers, as they are useful in the management of coronary heart disease as well by causing coronary arteries’ vasodilation and subsequent improvement of blood flow to the heart. Case Study Of Hypertension Discussion Paper

In conclusion, coronary artery disease is a major leading cause of death among adults globally. It is caused by factors that lead to vascular endothelial damage or accumulation of fat in the blood vessel walls, such as smoking cigarettes, obesity, and diseases such as hyperlipidemia, hypertension, and diabetes mellitus. The prevention and management of 80% of cardiovascular diseases relies on lifestyle diseases and control of other comorbid diseases. Therefore, for the patient in the case scenario, lifestyle modification to address their modifiable risk factor assumes a crucial role in addition to medication against their hypertensive urgency. Case Study Of Hypertension Discussion Paper

References

Bress, P. A., Anderson, S. T., Flack, M. J., Ghazi, L., Hall, E. M., Laffer, L. C., Still, H. C., Taler, J. S., Zachrison, S. K., & Chang, I. T. (2024). The management of elevated blood pressure in acute care: A scientific statement from the American Heart Association. Hypertension, 81(8). https://doi.org/10.1161/HYP.0000000000000238

Bull, C. F., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, P. M., Cardon, G., Carty, C., Chaput, J. P., Chastin, S., Chou, R., Dempsey, C. P., DiPietro, L., Ekelund, U., Firth, J., Friedenreich, M. C., Garcia, L., Gichu, M., Jago, R., Willumsen, F. J., et al. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451-1462. https://doi.org/10.1136%2Fbjsports-2020-102955

Seth, S. M., Aday, W. A., Almarzooq, I. Z., Cheryl, A. M. A., Pankaj, A., Christy, L. A., Carissa, M. B., Gibbs, B. B., Beaton, Z. B., Boehme, K. A., Mensah, C. Y., Currie, E. M., Elkind, V. S., Evenson, R. K., Generoso, G., Heard, G. D., Hiremath, S., Johansen, C. M., Kalani, R., Kazi, D. S., et al. (2024). 2024 Heart disease and stroke statistics: A report of US and global data from the American Heart Association. Circulation, 149(8), e347-e913. https://doi.org/10.1161/CIR.0000000000001209

Qiu, X. (2024). Nurse-led intervention in the management of patients with cardiovascular diseases: a brief literature review. BMC Nursing, 23(6). https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-023-01422-6 Case Study Of Hypertension Discussion Paper

Mr. R. is a 65-year-old African American man who presents to the Penmen Hospital a complaint of rapid weight gain and peripheral edema. He has a past medical history of coronary artery disease, hypertension, hyperlipidemia, and chronic renal insufficiency. He smokes tobacco daily and is obese. Upon arrival, his blood pressure reading was 172/91. He states that the reading is what he averages on his home blood pressure monitor. The provider considers prescribing a thiazide diuretic or calcium channel blocker for his treatment regimen.

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Describe the pathophysiology of coronary artery disease and how it relates to this case scenario.
Identify modifiable and nonmodifiable risk factors in this case scenario. As his nurse, explain how you would educate this patient regarding the modifiable risk factors identified in the above prompt.
Briefly discuss the classification of hypertension this patient is experiencing and explain the mechanism of action for the classes of drugs discussed in the scenario.

Follow the Case Study Guidelines and Rubric and answer questions using peer reviewed primary sources Case Study Of Hypertension Discussion Paper