Apa At Least 2 References Select One Of The Two Questions Fr

Apa At Least 2 Referencesselect One Of The Two Questions From The Disc

select one of the two questions from the discussion questions listed below. Discussion Question 1 CF is a sixty-year-old African American male who presents as a new patient for initial evaluation and follow-up. He has been diagnosed with hypertension for the last twelve years and Type 2 diabetes for the same period of time. His current blood pressure is 162/90, with a pulse of 76. His body mass index (BMI) is 32. He is currently taking Maxzide 37.5/25 mg every morning. This is the only antihypertensive medication he has taken. For this question, focus on the treatment of hypertension. Discuss the influences of his age, gender, and ethnicity on hypertensive medications. On the basis of an analysis of those factors, provide one option for improvement of his blood pressure and provide a clear and specific justification for that choice. Be sure to include dosage and scheduling. Include highlights of patient teaching and/or recommendations for any lifestyle changes. Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication. Discussion Question 2 MT is a fifty-six-year-old obese (BMI 31.5) Caucasian female with a significant family history of cardiovascular disease. She has uncontrolled hypertension and is currently taking metoprolol 50 mg twice daily. She has dyslipidemia and is taking exetimibe 10 mg daily and garlic. Her current cholesterol is 240 mg/dL, HDL is 41 mg/dL, LDL is 163 mg/dL, and triglycerides are 183 mg/dL. Her blood pressure today is 174/94, and her pulse is 90. Review the medications she is taking for hypertension and dyslipidemia. Evaluate the efficacy of these medications. Review them in terms of her age, gender, and ethnicity. Suggest any changes you would recommend, with clear justification for those choices. For medications, include dosages and schedules. Include highlights of patient teaching and/or lifestyle alterations. Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication.

Paper For Above instruction

The management of hypertension necessitates careful consideration of individual patient factors, including age, gender, ethnicity, comorbidities, and current medication regimens. This essay evaluates two hypothetical patient cases, with a focus on optimizing antihypertensive therapy based on evidence-based guidelines, pharmacologic principles, and patient-specific characteristics. The analysis centers on recommending effective treatment modifications, patient education strategies, and lifestyle interventions to improve blood pressure control.

Case 1: 60-year-old African American male with hypertension and diabetes

The first patient, CF, is a 60-year-old African American male with a longstanding history of hypertension and Type 2 diabetes mellitus. His current blood pressure of 162/90 mm Hg, lifestyle factors, and hemodynamic parameters suggest suboptimal control of hypertension. CF’s ethnicity, age, and gender significantly influence antihypertensive management because these factors affect drug responsiveness and risk profiles.

Evidence indicates that African American patients tend to respond better to calcium channel blockers (CCBs) and thiazide diuretics, whereas they are less responsive to ACE inhibitors or ARBs when used as monotherapy for hypertension (Flack et al., 2010). Moreover, older adults may have altered pharmacokinetics and increased susceptibility to side effects, necessitating cautious titration and monitoring. Male gender has been associated with higher baseline blood pressure levels and different cardiovascular risks compared to females, impacting treatment goals.

Given these considerations, an optimal treatment plan for CF involves adding a CCB such as amlodipine to his current regimen or switching to a combination therapy involving a thiazide diuretic, which may confer superior blood pressure lowering and cardiovascular protection (JNC 8, 2014). A recommended dosage could be Amlodipine 5 mg once daily, with titration to 10 mg as needed, depending on blood pressure response. The addition of hydrochlorothiazide 12.5 mg daily could be effective if tolerated, considering his BMI and comorbidities.

Patient education should emphasize adherence to medication, monitoring blood pressure regularly, and lifestyle modifications such as reducing sodium intake, engaging in regular physical activity, weight loss, and moderation of alcohol consumption. For instance, reducing sodium intake below 1500 mg per day can significantly improve blood pressure control, especially in African American populations (Appel et al., 2011).

In conclusion, tailoring antihypertensive therapy to the patient's ethnicity, age, and gender—favoring combination therapy with CCBs and diuretics—while emphasizing lifestyle change, can optimize blood pressure control and reduce cardiovascular risk.

Case 2: 56-year-old Caucasian female with uncontrolled hypertension and dyslipidemia

The second patient, MT, is a 56-year-old obese Caucasian female with uncontrolled hypertension and dyslipidemia, currently managed with metoprolol, ezetimibe, and garlic supplements. Her blood pressure of 174/94 mm Hg and lipid profile indicate poor control, and her medication regimen requires reevaluation in the context of her demographic and clinical profile.

Her current antihypertensive therapy, predominantly beta-blocker (metoprolol 50 mg twice daily), may be insufficient for comprehensive blood pressure management, especially considering her obesity and dyslipidemia. Beta-blockers are not first-line agents for uncomplicated hypertension and may worsen metabolic parameters such as lipid profiles and glucose control (Whelton et al., 2018).

Furthermore, her lipid parameters, particularly LDL cholesterol of 163 mg/dL and HDL of 41 mg/dL, warrant intensified lipid management aligned with guidelines. Lifestyle modifications focusing on weight loss, dietary fat reduction, increased physical activity, and smoking cessation are foundational, with pharmacotherapy tailored accordingly.

Considering her profile, an escalation of antihypertensive therapy to include an ACE inhibitor such as lisinopril 10 mg daily could be beneficial due to its proven benefits in reducing cardiovascular events and ameliorating some metabolic disturbances, especially in patients with risk factors (Chobanian et al., 2003). Combining this with her current regimen may improve blood pressure control. Alternatively, adding a thiazide-like diuretic, such as chlorthalidone 12.5–25 mg daily, could potentiate antihypertensive effects. Her medication schedule should be adjusted accordingly, with close monitoring of blood pressure and renal function.

For dyslipidemia, intensifying statin therapy—if not already in use—such as atorvastatin 40–80 mg daily, would align with guidelines aiming for LDL cholesterol below 100 mg/dL (Stone et al., 2014). Emphasizing lifestyle changes, including a Mediterranean diet low in saturated fats, weight loss targeted at reducing BMI, and increased physical activity, complements pharmacotherapy.

Patient education should focus on medication adherence, understanding hypertension’s risks, and lifestyle modifications to promote sustained blood pressure and lipid improvements. Regular follow-up is essential to evaluate efficacy and tolerability of therapy adjustments.

Conclusion

Optimizing hypertension management involves customizing therapy based on individual demographic and clinical factors, supported by evidence-based guidelines. For CF, a combination of CCBs and diuretics adjusted with consideration for ethnicity and age enhances control, coupled with lifestyle interventions. For MT, switching to agents like ACE inhibitors or ARBs and intensifying lipid management can reduce cardiovascular risk. Patient education remains integral to successful long-term management.

References

• Appel, L. J., et al. (2011). Dietary approaches to prevent and treat hypertension: A scientific statement from the American Heart Association. Hypertension, 57(2), 175-182.
• Chobanian, A. V., et al. (2003). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension, 42(6), 1206-1252.
• Flack, J. M., et al. (2010). Management of hypertension in Blacks: A scientific statement from the American Heart Association. Hypertension, 56(2), 250-265.
• Jeremiah W. (2014). 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. JAMA, 311(5), 507-520.
• Stone, N. J., et al. (2014). 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce cardiovascular risk. Journal of the American College of Cardiology, 63(25 Part B), 2889-2934.
• Whelton, P. K., et al. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension, 71(6), e13-e115.