7. entelpouls 5, Malehas Chamos Gea soprerin, teri, andepnepiine and ararlgily {ayorblesuvivalateriosptal earn ares «an lomisdclicltsil pia 2015310:270-279, ber) Fazer Punto, stack pacts sulcnesortne management of ain. agtation. ant 13 HYPERTENSION lla eee, Pharm, Feet Jer E.Tedle asm BCES,FCCR. APRA EAHA ‘ueanMINcosJEcTIVES rsestuy he rener shout + Casey Hood pressure aecoring to curent ype mara. + scuss complications (eta wan camage that spprepriate esta ations and arthypeen- ‘veregimens tase on pti speiiecharntestis, Provide appropriate ptint counseling or anthype ‘ensiedrugrepimens, ‘PATIENT PRESENTATION ‘rm hereto seem sew doctor fora check, fst excung over a cola Ove Im feating fine, xcept pote doctorpreseta ou sat let forme but ames Frankisn 4 yearcld back man who presenta is new amy maticne sian oreauaton an few apefhismedica plans Hepeneraly aa estates nat eis sii wc bang paced. sews iy i er peony cae psa sypet diabetes metus «yeFather die of acute 73. tne dit of ng Former smart year 49535 packer ten): ‘beharbeenaenadheret the low sedum et (tater ast what want) Ha down ounce regula, sndieLinited somewitfunctionay by his COFD. te ‘paltbareineursce tough hi employe: ‘amterene/yoenonehiaice37 5 mgi25 mg FOR ‘aula arlne 6 uns dally Doxazosin 2mgP0 04M Alncen A ct twoinhastons 4-6 FR short acinar Do tabeteQ 12H FRNcoughcongeion duaprnena20 gO Q8H PRAHA Atopusinot 200 mg FO aay coverthe part fewer. cmplainsfecsinal Inadaches wich cenit steals Herepors having ha two COPDevaee- besonttinehapast 1 onthe. He denis pene vomiting ahdominalpin, camping dares, cont De pysienstared nm on doszosn fe months 2. Mohs noprirhisoryofarthticsymptems and won ck ale otertely over inso acute 3P162/902m gating opst 164/92 mst HE espe) RB, 37°C WEDS hy HEI“en mildsnuedaiage AV cng tan ‘supple without maser bt no tot enarge- sentoriymphadenopthy Lang els cTA ately Fer blr mil Peston tasing so ere; nomares, bts orogenemegey Normal angadprostate NoceE:nospparnt jit sneng ste oftoph se or mtr snuey dite present Batak ‘alow dae, 561.007, 55) pte gene, (ptetons, (ttt, 808 ast RECOM aC 1-2/4pneptacet, Sepia soparmal ECG apa srt ates 2.Type2 0 contotatoncureat insu esmen 5.60" state on cunt een 4a ymptome improved en dxacois ‘questions Problem lentifiationNa 138 mEq/L Ca9,7 mg/dL K 4.7 mEq/L Mg 2.3 mEq/L 199 mEq/L AIC 6.1% CO,27 mEq/L Alb 3.4 g/dL. BUN 22 mg/dL Hb 13 g/dL SCr2.2 mg/dL Het 40% Glucose 110 mg/dL WBC 9.0 x 10/mm* Uric acid 6.7 mg/dL. Plts 189 x 10°/mm? Fasting lipid Spirometry panel (6 months ago) Total Chol FVC 2.38 L 161 mg/dL (54% pred) LDL 79 mg/dL. FEV, 1.21 L HDL 53 mg/dL (38% pred) TG 144 mg/dL FEV,/FVC 51%1.) How would yous ths patents HT accord sngto cures guideline? 1. what erdencf tne rg damage orn! Desired outcome 2.Ln the gone of treme fr this ptient Gncaing as potbsod pees) ‘TherpeatcAernatives 3.4. wnat reste mofatons shout encourage ‘orth patient toby achowe and masta adegute 5.0 wnat easonabie parmacotnerapeutlcoptions are _hannacologhe therapy fois HTH? How might ‘optimal Plan ‘4a. secommend spec tebe modification fothis 4¢-ounee spetcandappropiatephasmacthe Incating drut dose), dosage rom, and sen sae, onteme Pabution oui ne monitored aerating tne regimen nd thoughout ha trntment ours? A what it Pavone Bvestion (6. anced on your secommendstons, rove spp 1 Deeb tne mao eauses of secondary HtNanat ‘the mcthade been hat cold boule out inthe ‘he pharmacotherapete pon forthe patente Ind aston ofeach ofthe owing cores or + tchanicbear deere th tory of + sonora dene uatral or unser5: Descibehow you would expan toapatlen nowt ooestownin i 12 er sp Phas amor dita oma od pressure melt (Phot curen of ARD Meal Mit, California) ‘CLINICAL PEARLS 1 Tense ot hemorrhage stoke aye nteased by these fap therapy ia patents with uncoaisbad HatenaP> 150/90mm 2. Temajntyat hypertensive patents weal 2. Suro Si Jateon J, Basbano Et ofl seudoepbdtnon od pressure ae hear at a ratcegueies or thes management ot apeten- opinthecommunky statement bythe Ameian cf ypertension. Jin Hypertension 20162614-26. sot0.11 1912237, 2: james Opa, carter Leta. 2014 Even bas guidatinfrtheeanagarnent high sd pe ‘othe igth pint satianal commitee IC) JAMA 2013. d:10.1001ama2015.264427, lealatindabaee 2046, Date Can 208699(2 supptist2 6a le, Ard et ab. 2013 AA? ‘Ace gusineon fase managsmenttoreduce loge cardilogy/amerian ase aerciaton Taskforce on pracie gd. Cireaton 201. 7 Dangle 6, Babi, epee etal tanagemant thigh ood pressure in Asean Amerie conse Working Group ofthe nterntiona Society on paren tito tfectsofanangiotensnconmertingeneyme Inntor mip on teoveseua vets ngs tients Eng) Med 2000;542:145-153 InvegwasEhets oc ramiplloncadiovscaarand tus ests ofthe HOPE study ad the AUCRO-HOPE su sly Lanet 1006355:255-258, aetna eet‘orazosin vs torthatdone: the Athypetansiveane (ALLHAD 148A 2000;285:1967-2975, 2a Mews thang 26D otal cacy and eft of ‘gl sted 2006 354131-140, 14 HYPERTENSIVE CRISIS. oot eat Need Tose erat ‘mas Nawarsas, Pare, BPS eaRMINconjEcTiVEs ‘arcer comping seas stay te ener sous cingulate hypertnsie urgency fom a peta ety sateen oa fore patent witha pester + beedopanappropiate rattan fora pent ‘witha bypertenive css shout pertenion GFT) sn the important pro. ‘PATIENT PRESENTATION rmnavingtroute seeing and my mete he sited tothe emergency department with chit compat oft seing and chest ents. esses ry Woon tha has ees appeningofl anon forthe few days A fet t wou ust ast rogtessvety more angering shetty arutbted as tober yes jst geting ol” bat sowie rare concerned ‘that maybe someening se, Te cesta state yesterday an was tay ery occuring realy with ost. However chs since goten moe ‘souberome nde Imitng herder Wl ‘compitay eatin She tried telmecestoby ting ‘ double doseatranitine st night and another dose thicmoming bu he says that didnt lp, shoalso states nat aicoroe ser tet 0 Ne _netseophapeal flac While rete inthe emerency (phot) Shohar apart mace story sgnicant or HTM apa gastoesopagea re. shohad een aking inopilndbydrochorothsdo roe several yess wth good Hoo pressureconL bt sou months agoshestopped aking mediines duhterout of sateand end up staying wither for ‘ couleet months Soe her daughter tes nat sea with pharmacy nety, she ever ot there ‘ations vet when shea out Ar seve ays Ms ‘he metoes, consequent she never esumed then