Differential Diagnosis and Management of Hypertension in an African American Male- A Tailored Treatment Approach

Differential Diagnosis and Management of Hypertension in an African American Male- A Tailored Treatment Approach

In the client’s case presented, the presumptive diagnosis is hypertension. Hypertension is a silent disease that is often diagnosed incidentally during clinical visitation for other illnesses. Subjective findings on the case presented revealed features suggestive of hypertension. To begin with, headaches that won’t seem to go away, accompanied by occasional blurred vision among adults, are early presentations of hypertension. The patient in the case also demonstrated some of the risk factors for the disease, such as psychological stress and Black race. This further affirms the hypertension diagnosis.

Comprehensive management of hypertension combines non-pharmacological interventions with pharmacotherapy. According to the practice guidelines for managing essential hypertension among Black patients with no other comorbidity, calcium channel blockers (CCB) are the preferred first-line instead of ACEIs and ARBs (Flack & Buhnerkempe, 2022). In this case, the patient will be started on low-dose Amlodipine. Amlodipine can be used as monotherapy or in combination with other agents to optimize BP control. Thiazide diuretics also maintain effectiveness in lowering blood pressure among Black hypertensive patients. Thiazide diuretics such as hydrochlorothiazide can be used alongside CCBs to optimize BP control in patients who fail to attain optimal BP control upon monotherapy with CCBs. They can also be used as alternatives to CCBs in patients who develop adverse events from CCB use.

The drug class that should be avoided is the ACEIs and ARBs. This is because these classes have, for a long time, been reported to be less effective in lowering blood pressure and preventing cerebrovascular accidents (Colvin et al., 2020). Notwithstanding, ACEIs or ARBs can be used in the presence of hypertension and chronic kidney disease comorbidity.
Non-pharmacological measures can be applied to optimize BP control. Lifestyle modification to restrict salt intake, physical exercise, smoking cessation, and good sleep hygiene maintenance can help optimize BP control.

References

Colvin, C. L., King, J. B., Oparil, S., Wright, J. T., Ogedegbe, G., Mohanty, A., Hardy, S. T., Huang, L., Hess, R., Muntner, P., & Bress, A. (2020). Association of Race/ethnicity-specific changes in antihypertensive medication classes initiated among Medicare beneficiaries with the Eighth Joint National Committee Panel member report. JAMA Network Open, 3(11). https://doi.org/10.1001/jamanetworkopen.2020.25127
Flack, J. M., & Buhnerkempe, M. G. (2022). Race and antihypertensive drug therapy: Edging closer to a new paradigm. Hypertension, 79(2), 349–351. https://doi.org/10.1161/

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The professor is asking us based on our differential diagnosis project in PowerPoint

What did you finally diagnose your patient with? If hypertension, what are you treating him with and why?

Differential Diagnosis and Management of Hypertension in an African American Male- A Tailored Treatment Approach

Keep in mind he is an African American male, which drug class should you avoid or use and why?