Hypertension Secondary in Systemic Sclerosis Patients Discussion

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Hypertension Secondary in Systemic Sclerosis Patients Discussion

 

Management Plan

Primary Diagnosis with ICD-10 Code

Primary Diagnosis: Hypertension, primary (essential) ICD-10 Code: I10

The patient’s elevated blood pressure readings in both arms (172/94 and 178/98) and associated symptoms of headache, tiredness, and sleep disturbances due to snoring indicate hypertension as the primary diagnosis. Hypertension, according to Iqbal and Jamal (2019), is a widespread condition and a substantial risk factor for cardiovascular disease. These include heart attacks and strokes. The patient’s BMI of 28.7 and poor diet are also contributory factors.

  1. CPT Code for Initial Evaluation: 99204 (Comprehensive new patient office visit)
  2. Nurse Lab Draws: CMP (Comprehensive Metabolic Panel) and Lipid Panel
  • Vaccinations Given: Ensure the patient is up to date on recommended vaccinations, including influenza and pneumococcal vaccines. Hypertension Secondary in Systemic Sclerosis Patients Discussion

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Guidelines Used to Develop This Primary Diagnosis

The diagnosis of primary hypertension is based on the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-8) guidelines. These guidelines define hypertension as blood pressure greater than 130/80 mm Hg (Banga et al., 2019).

Differential Diagnoses with Rationale and Resources

  1. Hypertension, secondary: Secondary hypertension may be considered if the primary diagnosis does not respond adequately to treatment. It may also be considered if additional symptoms and history suggest an underlying cause like renal disease or endocrine disorders (Ruaro et al., 2022).
  2. Hypertension, white coat/pseudoresistant: White coat hypertension is possible if the patient’s elevated blood pressure readings are only observed in clinical settings but not in other environments. Ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring can help rule out this diagnosis.
  3. Obstructive Sleep Apnea: Given the patient’s report of snoring and sleep disturbances, obstructive sleep apnea should be considered a differential diagnosis (Gottlieb & Punjabi, 2020). Polysomnography (sleep study) may be needed to confirm this condition. Hypertension Secondary in Systemic Sclerosis Patients Discussion

Medications, Dosage, Education, Additional Ancillary Tests, Referrals, and Follow-Up

Medications: Initiate antihypertensive therapy with consideration of lifestyle modifications.

  1. Medication: ACE inhibitor (Lisinopril)
  2. Dosage: Start with Lisinopril 10 mg daily, titrate as needed based on blood pressure response.
  • Education: Educate the patient about the necessity of drug adherence, possible adverse effects, and the necessity for periodic follow-up sessions.

Additional Ancillary Tests:

  1. Ambulatory Blood Pressure Monitoring (ABPM): To confirm the diagnosis and assess for white coat hypertension.
  2. Polysomnography: If obstructive sleep apnea is strongly suspected based on symptoms.

Referrals:

  1. Cardiologist: Refer the patient to a cardiologist for further evaluation and management of hypertension.
  2. Sleep Specialist: If obstructive sleep apnea is diagnosed or strongly suspected.

Follow-Up: Arrange a follow-up session in 2-4 weeks to examine the patient’s reaction to treatment and, if required, alter prescriptions.

Problem Statement

The patient, a 57-year-old Hispanic individual, presents with high blood pressure, associated symptoms of headache, tiredness, sleep disturbances due to snoring, and a 10-pound weight gain over the last year. The BMI is 28.7, indicating overweight, and the patient reports a poor diet. Physical examination reveals elevated blood pressure readings in both arms, laterally displaced PMI, and prominent arteriovenous (AV) nicking with a 3:1 ratio. The primary concern is managing primary hypertension and assessing potential secondary causes or comorbid conditions. Hypertension Secondary in Systemic Sclerosis Patients Discussion

Social Determinants of Health, Health Promotion, and Patient Risk Factors

Social Determinants of Health: Assess the patient’s socioeconomic status, living conditions, access to healthcare, and support system. Address any identified barriers to medication adherence and lifestyle modifications.

Health Promotion: Emphasize the importance of lifestyle modifications. These include dietary changes, regular physical activity, and weight management.

Patient Risk Factors: Recognize the risk factors, like ethnicity and family history of hypertension. Provide education on risk reduction strategies, including smoking cessation if applicable.

 

References

Banga, S., Mungee, S., Patel, A. R., Singh, S., Kizhakekuttu, T. J., & Kizhakekuttu, T. (2019). Management of resistant hypertension based on recommendations from different guidelines and the systolic blood pressure intervention trial. Cureus, 11(8). https://doi.org/10.7759/cureus.5371

Gottlieb, D. J., & Punjabi, N. M. (2020). Diagnosis and management of obstructive sleep apnea: a review. Jama, 323(14), 1389-1400. https://doi.org/10.1001/jama.2020.3514

Iqbal, A. M., & Jamal, S. F. (2019). Essential hypertension.

Ruaro, B., Salton, F., Baratella, E., Confalonieri, P., Geri, P., Pozzan, R., … & Hughes, M. (2022). An overview of different techniques for improving the treatment of pulmonary hypertension secondary in systemic sclerosis patients. Diagnostics, 12(3), 616.  Hypertension Secondary in Systemic Sclerosis Patients Discussion

Management Plan

Primary Diagnosis with ICD-10 Code

Primary Diagnosis: Hypertension, primary (essential) ICD-10 Code: I10

The patient’s elevated blood pressure readings in both arms (172/94 and 178/98) and associated symptoms of headache, tiredness, and sleep disturbances due to snoring indicate hypertension as the primary diagnosis. Hypertension, according to Iqbal and Jamal (2019), is a widespread condition and a substantial risk factor for cardiovascular disease. These include heart attacks and strokes. The patient’s BMI of 28.7 and poor diet are also contributory factors.

  1. CPT Code for Initial Evaluation: 99204 (Comprehensive new patient office visit)
  2. Nurse Lab Draws: CMP (Comprehensive Metabolic Panel) and Lipid Panel
  • Vaccinations Given: Ensure the patient is up to date on recommended vaccinations, including influenza and pneumococcal vaccines.

Guidelines Used to Develop This Primary Diagnosis

The diagnosis of primary hypertension is based on the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-8) guidelines. These guidelines define hypertension as blood pressure greater than 130/80 mm Hg (Banga et al., 2019).

Differential Diagnoses with Rationale and Resources

  1. Hypertension, secondary: Secondary hypertension may be considered if the primary diagnosis does not respond adequately to treatment. It may also be considered if additional symptoms and history suggest an underlying cause like renal disease or endocrine disorders (Ruaro et al., 2022).
  2. Hypertension, white coat/pseudoresistant: White coat hypertension is possible if the patient’s elevated blood pressure readings are only observed in clinical settings but not in other environments. Ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring can help rule out this diagnosis.
  3. Obstructive Sleep Apnea: Given the patient’s report of snoring and sleep disturbances, obstructive sleep apnea should be considered a differential diagnosis (Gottlieb & Punjabi, 2020). Polysomnography (sleep study) may be needed to confirm this condition. Hypertension Secondary in Systemic Sclerosis Patients Discussion

Medications, Dosage, Education, Additional Ancillary Tests, Referrals, and Follow-Up

Medications: Initiate antihypertensive therapy with consideration of lifestyle modifications.

  1. Medication: ACE inhibitor (Lisinopril)
  2. Dosage: Start with Lisinopril 10 mg daily, titrate as needed based on blood pressure response.
  • Education: Educate the patient about the necessity of drug adherence, possible adverse effects, and the necessity for periodic follow-up sessions.

Additional Ancillary Tests:

  1. Ambulatory Blood Pressure Monitoring (ABPM): To confirm the diagnosis and assess for white coat hypertension.
  2. Polysomnography: If obstructive sleep apnea is strongly suspected based on symptoms.

Referrals:

  1. Cardiologist: Refer the patient to a cardiologist for further evaluation and management of hypertension.
  2. Sleep Specialist: If obstructive sleep apnea is diagnosed or strongly suspected.

Follow-Up: Arrange a follow-up session in 2-4 weeks to examine the patient’s reaction to treatment and, if required, alter prescriptions.

Problem Statement

The patient, a 57-year-old Hispanic individual, presents with high blood pressure, associated symptoms of headache, tiredness, sleep disturbances due to snoring, and a 10-pound weight gain over the last year. The BMI is 28.7, indicating overweight, and the patient reports a poor diet. Physical examination reveals elevated blood pressure readings in both arms, laterally displaced PMI, and prominent arteriovenous (AV) nicking with a 3:1 ratio. The primary concern is managing primary hypertension and assessing potential secondary causes or comorbid conditions. Hypertension Secondary in Systemic Sclerosis Patients Discussion

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Social Determinants of Health, Health Promotion, and Patient Risk Factors

Social Determinants of Health: Assess the patient’s socioeconomic status, living conditions, access to healthcare, and support system. Address any identified barriers to medication adherence and lifestyle modifications.

Health Promotion: Emphasize the importance of lifestyle modifications. These include dietary changes, regular physical activity, and weight management.

Patient Risk Factors: Recognize the risk factors, like ethnicity and family history of hypertension. Provide education on risk reduction strategies, including smoking cessation if applicable. Hypertension Secondary in Systemic Sclerosis Patients Discussion

References

Banga, S., Mungee, S., Patel, A. R., Singh, S., Kizhakekuttu, T. J., & Kizhakekuttu, T. (2019). Management of resistant hypertension based on recommendations from different guidelines and the systolic blood pressure intervention trial. Cureus, 11(8). https://doi.org/10.7759/cureus.5371

Gottlieb, D. J., & Punjabi, N. M. (2020). Diagnosis and management of obstructive sleep apnea: a review. Jama, 323(14), 1389-1400. https://doi.org/10.1001/jama.2020.3514

Iqbal, A. M., & Jamal, S. F. (2019). Essential hypertension.

Ruaro, B., Salton, F., Baratella, E., Confalonieri, P., Geri, P., Pozzan, R., … & Hughes, M. (2022). An overview of different techniques for improving the treatment of pulmonary hypertension secondary in systemic sclerosis patients. Diagnostics, 12(3), 616. Hypertension Secondary in Systemic Sclerosis Patients Discussion