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American Heart Association (AHA) recommendations for the patient management
At the time of going to the clinic, the patient has hypertension stage 2. Following the present recommendations, the patient should be recommended to implement lifestyle changes to make it healthy. Besides, at this stage of Hypertension, his medication should include two BP-lowering medications of different classes; thus, the intensification of therapy is obligatory. If the patient has not been assessed for the 10-years for heart disease and stroke, the ASCVD risk calculator shall be used to provide him with the relevant information, therapy, and recommendations. In one month, the patients state has to be reassessed. If his state is stabilized, the next reassessment shall take place in 3-6 months. If it is not, the next reassessment will be in 1 month. Until the state of the patient is under control, a monthly follow-up shall be conducted.
Patients recommendations using Framingham Global Risk Model
The Framingham Global Risk Model is used in many ways among different populations and is recognized to be one of the most informative methods. It is based on comprehensive history, vital sign assessment, use of risk assessment tools, diagnostic testing, and serum lab work. Its best tool assesses cardiovascular outcome, presence of risk factors, the population of interest, and, finally, risk timeline. Patients need to understand that all Framingham tools are different; some are aimed to evaluate the risk of MI and risk of death only, while others also calculate heart-related chest pain. Moreover, the patients should be tested for markers of thrombosis, plaque formation, abnormal endothelial function, and other factors of atherosclerosis development. It is also obligatory to control the ankle-branchial index, high-sensitivity C-reactive protein, and arterial stiffness degree (Coke, 2016). Moreover, most risk calculators do not include family history, so the real risk can be different than the evaluation indicates.
Recommended medications for primary or secondary cardiovascular disease (CVD) prevention and treatment of uncontrolled Hypertension
CVD is primarily caused by dyslipidemia, which, in turn, may cause atherosclerotic CVD. Medical professionals prefer using statin therapy to control blood lipids. Statins are the drugs, lowering lipids, so the body is inhibited from creating cholesterol. In the case of CVD, statins are used both in primary and secondary prevention (Jones et al., 2018). Another target factor for CVD prevention is blood pressure <140/90 mmHg.
Uncontrolled or resistant Hypertension implies the application of 3 or more antihypertensives. The first choice is a blocker of the renin-angiotensin system. It can be either an angiotensin-converting enzyme or an angiotensin receptor blocker. This medication is usually used at maximally tolerated doses for uncontrolled hypertension treatment. Moreover, it is obligatory to include long-acting calcium channel blockers. Finally, the scheme should include diuretic (normally thiazide-like, for example, hydrochlorothiazide or chlorthalidone) (Yaxley & Thambar, 2015). In the most severe cases of the disease, this therapy can be modified by adding more medications or altering the doses.
The possible side effects of the prescribed drugs
The most common side effects of almost all hypotensive drugs include cough, weakness, and postural hypotension. Other possible side effects include, but are not limited to, diarrhea or constipation, nausea or vomiting, dizziness, headache, erection problems, increased nervousness, rash, etc. Nevertheless, the side effects of hypotensive drugs are often absent or very mild. Diuretics most often can cause such side effects as extra urination, fatigue, leg cramps, rarely foot pain.
References
Coke, L. A. (2016). The Framingham global risk assessment tools. Web.
Jones, R., Arps K., Davis, D. M., Blumenthal R. S., & Martin, S. S. (2018). Clinician Guide to the ABCs of primary and secondary prevention of atherosclerotic cardiovascular disease. Web.
Yaxley, J. P., & Thambar, S. V. (2015). Resistant Hypertension: an approach to management in primary care. J Family Med Prim Care, 4(2), 193-199. Web.
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