medications in AO’s drug treatment plan may need to be adjusted until adequate blood pressure is achieved and controlled. Furthermore, it should be noted the thiazide type diuretics are the initial recommend therapy for hypertension (Laureate Education, 2012), unless there are other compelling or specific indications for another drug treatment (Barranger, 2013). According to the case study, there does not appear to be any reported contraindications to thiazide therapy. Therefore, I would consider a daily dose of hydrochlorothiazide 12.5 mg, daily, if necessary.
The addition of a thiazide diuretic may negate the need for the current atenolol, a beta-blocker that may not be indicated in a patient with no other cardiac history (Barranger, 2013). The hydralazine in AO’s current medication regimen may be beneficial for its hypertension control secondary to the patient’s obesity. While the doxazosin may be helpful in both blood pressure and cholesterol management. However, it would be very crucial to discuss the impact obesity can have on the pathogenesis of both hypertension and hyperlipidemia with AO. The patient should be informed that through lifestyle changes, his current medication regimen may be reduces or possibly eliminated. According to Barranger (2013), weight reduction to a normal body (BMI of 18.5 to 24.9) can reduce systolic blood pressure by 5-20 mmHg. Furthermore, significant reduction of systolic blood pressure can also be achieved through adoption of a DASH diet, which is low-salt, low-fat, rich in fruits and vegetables (Barranger, 2013). The decision to treat hyperlipidemia with drug therapy is base on low-density lipoprotein levels (Barron, 2013). Simvastatin, a statin drug, is the first line of therapy for hyperlipidemia. This seems to be an appropriate medication choice for AO; however, patients should try lifestyle changes for approximately six months prior to initiating drug therapy (Barron, 2013). Therefore, again stressing the importance of lifestyle changes for AO would be critical, especially considering his history of obesity and recent weight gain.
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- Summer '15