Apa Format Discussion Assignment: Hypertension By Ally A, 49

Apa Format Discussion Assignment Hypertensiondr Ally A 49 Year Ol

Dr. Ally, a 49-year-old professor, was diagnosed with essential hypertension 12 years ago and was on antihypertensive drugs. However, he did not take his medications last year because he was feeling just fine. In addition, he was very busy with work. Nevertheless, he felt tired after work and developed dyspnea while climbing the stairs. Recently, he had a bout of epistaxis (severe nose bleed) with dizziness and blurred vision. He went to the doctor for a checkup. His blood pressure was 180/110, and the doctor found rales or crackles on his chest upon auscultation. The doctor ordered rest and asked him to start his medication again.

This case presents multiple health issues related to uncontrolled hypertension and its complications. The primary problems include persistent high blood pressure, symptoms of end-organ damage such as visual changes and dyspnea, episodes of epistaxis, and potential development of congestive heart failure. The patient's failure to adhere to his antihypertensive medication regimen has resulted in significant elevations in blood pressure, which predisposed him to cardiovascular problems and acute hypertensive emergencies.

In hypertension, pathophysiological changes impact various organs, notably the eyes and heart. In the eye, prolonged hypertension can cause hypertensive retinopathy, characterized by narrowed arterioles, arteriovenous nicking, hemorrhages, and swelling of the optic disc (Wong et al., 2010). These changes are due to damage to retinal blood vessels caused by increased vascular pressure and eventual rupture of microvasculature. The increased blood pressure leads to vasoconstriction and damage to the endothelium, resulting in ischemia and hemorrhages.

Regarding the heart, hypertensive stress over time causes left ventricular hypertrophy (LVH), which is a compensatory mechanism to withstand increased afterload. This adaptive process involves thickening of the ventricular wall, which initially maintains cardiac output but eventually leads to decreased compliance and diastolic dysfunction. Over time, the heart's ability to pump effectively diminishes, increasing the risk of heart failure. Given the clinical context—dyspnea, crackles on auscultation, and elevated blood pressure—this patient might have developed congestive heart failure. The question of whether it is right-sided or left-sided depends on the predominant features. Since he exhibits dyspnea and crackles mostly localized to the lungs, it suggests left-sided heart failure, which results from left ventricular failure causing pulmonary congestion (Yancy et al., 2013).

The treatment likely involved antihypertensive medications aimed at controlling blood pressure and preventing further end-organ damage. Common classes of medications include ACE inhibitors, beta-blockers, diuretics, calcium channel blockers, and vasodilators. For this patient, ACE inhibitors such as enalapril or lisinopril might have been prescribed, as they reduce blood pressure by inhibiting the conversion of angiotensin I to angiotensin II, leading to vasodilation and decreased aldosterone secretion, which reduces fluid retention. Similarly, calcium channel blockers like amlodipine, which inhibit calcium entry into vascular smooth muscle, cause vasodilation and decrease systemic vascular resistance (Khan et al., 2017).

Two antihypertensive drugs and their mechanisms include:

  • ACE inhibitors (e.g., Enalapril): These drugs block the angiotensin-converting enzyme, preventing the formation of angiotensin II, a potent vasoconstrictor. The result is vasodilation, decreased afterload, and reduced aldosterone-mediated volume expansion.
  • Beta-blockers (e.g., Metoprolol): These medications block beta-adrenergic receptors in the heart, reducing sympathetic stimulation, decreasing heart rate, myocardial contractility, and subsequently lowering blood pressure and cardiac workload.

In conclusion, uncontrolled hypertension in Dr. Ally has led to hypertensive end-organ damage, including hypertensive retinopathy and possible congestive heart failure. Effective management involves adherence to antihypertensive therapy and monitoring for complications. Pharmacological agents like ACE inhibitors and beta-blockers act through different mechanisms to reduce blood pressure and mitigate cardiovascular risk, underscoring the importance of tailored pharmacotherapy in hypertensive patients.

References

  • Yancy, C. W., Jessup, M., Bozkurt, B., et al. (2013). 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62(16), e147-e239.
  • Khan, M. S., & Bawa, B. (2017). Clinical pharmacology of antihypertensive drugs. Current Pharmacology Reports, 3(4), 285-293.
  • Wong, T. Y., Mitchell, P., & Liew, G. (2010). Hypertensive retinopathy and risk of stroke. JAMA, 304(17), 2020–2022.
  • Fletcher, R., & Wachtell, K. (2019). Impact of antihypertensive therapy on left ventricular hypertrophy. Current Hypertension Reports, 21(4), 28.
  • Brady, P. W., & Sorbo, L. (2019). Pathophysiology of hypertensive heart disease. Cardiology Clinics, 37(3), 303-312.
  • Whelton, P. K., Carey, R. M., & Aronow, W. S., 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. Journal of the American College of Cardiology, 71(19), e127-e248.
  • Murphy, M. P., & Kovesdy, C. P. (2020). Hypertensive retinopathy and cardiovascular risk. Current Hypertension Reports, 22(3), 14.
  • Wright, J. T. Jr., Williamson, J. D., & Whelton, P. K., et al. (2017). A randomized trial of intensive versus standard blood-pressure control. The New England Journal of Medicine, 378(22), 2103-2116.
  • Joshi, P., & Prabhakaran, D. (2020). Management of hypertensive heart disease. European Heart Journal, 41(12), 1030-1039.
  • Brown, M. J., & Williams, B. (2018). Pathogenesis and management of hypertensive target organ damage. Journal of Clinical Hypertension, 20(4), 677-684.

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