For people aged 18 to 59 without major health issues, the ideal blood pressure target is 140/90 mm Hg.

For people aged 18 to 59 without major health issues, the ideal blood pressure target is 140/90 mm Hg. If someone has high blood pressure, the first line of treatment should be thiazide-type diuretics, calcium channel blockers, ACE inhibitors, and ARBs. It is necessary to start treatment with a calcium channel blocker like amlodipine or a thiazide-type diuretic like hydrochlorothiazide, either on its own or in combination with other medications.

Furthermore, it important to keep in mind that the primary outcome of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) studies was the same for diuretics, calcium channel blockers, and ACE inhibitor. The use of CCBs or blockers is also beneficial. The use of monotherapy with blockers or ACEIs, on the other hand, is less effective in African Americans compared to Caucasians.

Some antihypertensive drugs work better on African Americans than others. Diuretics have been shown in controlled trials to reduce morbidity and mortality in African Americans (Rosenthal & Burchum, 2021). As a result, diuretics are the first-line treatment.

 

Q2

For African American adults dealing with hypertension, the initial treatment should involve either a thiazide-type diuretic or calcium channel blockers. For those in stage 2 hypertension, experts suggest starting with two antihypertensive medications. Thiazide diuretics like Chlorthalidone or Hydrochlorothiazide, along with a calcium channel blocker like Amlodipine (Norvasc), have proven effective for individuals of African descent. Initially, a daily dose of Amlodipine at 5mg and Hydrochlorothiazide at 12.5mg is recommended. If necessary, the Hydrochlorothiazide dose can be increased to 25 or 50mg daily, but caution is advised not to exceed 50mg daily due to the risk of hyperkalemia (Herman & Bashir, 2021). The reason for this recommendation is that some blood pressure drugs are more effective for African Americans. Controlled trials have demonstrated that diuretics, in particular, lower the risk of health problems and death among African Americans (Rosenthal & Burchum, 2021). That is why diuretics are the preferred option.

Q3

Amlodipine works to reduce blood pressure and peripheral vascular resistance by relaxing the smooth muscle in coronary blood vessels. It achieves this by blocking the transmembrane entry of calcium ions into both cardiac and vascular smooth muscles, ultimately leading to increased coronary vasodilation (Herman & Bashir, 2021).

Hydrochlorothiazide acts by inhibiting sodium reabsorption in the distal tubules, which, in turn, enhances the excretion of sodium, potassium, magnesium, hydrogen ions, and water. This stimulation of urine production occurs through the inhibition of sodium and chloride reabsorption in the early segment of the distal convoluted tubule (Rosenthal & Burchum, 2021).

Hydrochlorothiazide facilitates diuresis in the renal tubes, leading to increased urine output. This, in turn, reduces blood volume, effectively lowering blood pressure. On the other hand, Amlodipine induces relaxation in blood vessels, facilitating the flow of blood away from the heart to various parts of the body and resulting in decreased blood pressure.

Q4

Hydrochlorothiazide: Research indicates that most side effects associated with hydrochlorothiazide are usually dose-dependent. Some potential side effects include overall weakness, low blood pressure, nausea, vomiting, diarrhea or constipation, and cramping. Hypersensitive individuals may experience rash, pulmonary edema, or fever. Additional side effects may include dizziness, vertigo, and headaches (Herman & Bashir, 2021).

Amlodipine (Norvasc): Common side effects of this medication, such as headaches, dizziness, and drowsiness, are typically observed in patients starting the treatment. Changes in bowel habits like diarrhea, constipation, and indigestion may also occur. Muscle cramps and leg swelling are among the other potential side effects (EMC, 2021).

Atorvastatin (Lipitor): Side effects may involve muscle pain, tenderness, or weakness. Additional potential side effects include diarrhea, upset stomach, and irritation in the nose or throat (Memorial Sloan Kettering Cancer Center, 2021). If these side effects persist, it is advisable to discontinue the medication and consult with your healthcare provider.

Q5

When Hydrochlorothiazide is taken with alcohol, it may increase the risk of lithium toxicity and raise the chance of low potassium when combined with certain drugs like digitalis glycoside, astemizole, sotalol, terfenadine, and pimozide. There’s also a higher risk of low blood pressure when HCT is taken with barbiturates and opioids, and combining it with an ACE inhibitor may add to the risk of initial low blood pressure (Herman & Bashir, 2021).

Having grapefruit or grapefruit juice with Amlodipine increases its levels in the blood, while St. John’s wort decreases these levels. Immunosuppressive drugs can also raise Amlodipine levels in the bloodstream. To avoid serious side effects and potential toxicity, it’s important to steer clear of grapefruit and grapefruit juice when taking Amlodipine along with other medications (Herman & Bashir, 2021).

Q6

1. Recommend the patient to adopt a heart-healthy diet like the DASH (Dietary Approaches to Stop Hypertension) diet, which involves reducing sodium and saturated fat intake.
2. Encourage regular physical activity, aiming for at least 150 minutes of moderate-intensity exercise per week. This can help in weight loss and help control blood pressure.
3. Discuss strategies for weight loss, considering that obesity is a significant risk factor for hypertension and hyperlipidemia. Gradual and sustained weight loss is a beneficial goal.
4. Suggest the patient monitor blood pressure at home and maintain a log. Regular follow-up appointments for assessing and adjusting the treatment plan are crucial (Verma et al., 2021).

References

EMC. (2021). Amlodipine 10mg tablets. Dr. Reddy’s Laboratories. 

Heart Disease in High-Risk Patients with Hypertension in Spain (The CORONARIA Study). Journal of International Medical Research, 36(6), 1399–1417. Retrieved on March11, 2023. Retrieved from 

Herman, L.L. & Bashir, K. (2021). Hydrocholorothiazide. StatePearls.

Mclver, L.A. & Siddique, M.S. (2021). Atorvastatin. StatPearls Publishing LLC. 

Memorial Sloan Kettering Cancer Center. (2021). Patient & caregiver education: atorvastatin. 

Rosenthal, L.D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for Advanced Practice Nurses (2nd ed.). St. Louis, MO: Elsevier.

Verma, N., Rastogi, S., Chia, Y. C., Siddique, S., Turana, Y., Cheng, H. M., … & Kario, K. (2021). Non‐pharmacological management of hypertension. The Journal of Clinical Hypertension, 23(7), 1275-1283.