Hypertension Topic Discussion Case

CC: I am feeling better, but I still feel stressed from working all day.

HPI:

Jim is a 55-year-old white male with a history of HTN, DM, hypothyroidism, and MDD presenting today
at the CVRR clinic for his one month follow up. The patient reports to have been working on improving
his diet by cutting back on fast food and going on daily walks with his new dog. He reports that he has
been taking all of his medications as prescribed and that he has been feeling better since his last visit
with the lifestyle changes, he has made. He states he has been cutting back on his drinking and only
drinks a few drinks a day with dinner and still enjoys a few cigarettes after the kids go to bed. During his
last visit Jim’s amlodipine was increased to 10 mg daily due to his high blood pressure.

ROS: negative except as stated in HPI

HEENT: no rhinorrhea or sore throat

Abd: no distention, no abdomen pain

Ext: no tremors

Social History:

Marital Status: married

Number of children:2

Highest level of education: high school diploma

Occupation: Construction worker

Alcohol: 4 beers nightly with dinner

Smoking: 3 cigarettes daily

Current Medications:

- Escitalopram 20 mg daily

- Losartan 100 mg PO daily

- Metformin 500 mg PO BID

- Glipizide 10 mg PO BID

- Levothyroxine 100 mcg PO daily

- Amlodipine 10 mg PO daily
Allergies: Cough-lisinopril

Labs:

- A1C 7.1

- Blood Glucose: 120

- AST: 20

- ALT:22

- TSH: 0.924

- Scr 1.1

Vitals 02/16/23: 98.2; 146/42 mmHg, 62 bpm; 20 RR

1. What category of hypertension does Jim meet?

2. What nonpharm recommendation could Jim be counseled on today?

3. What additional labs would you like to monitor for this patient based on his medication?

4. What drug therapy would you recommend for treatment of Jim’s hypertension?