Patient: J.T. Weight: 250 BP: 152/88 Age: 46 yo Height: 5’7″ P: 84 Gender: Male BMI: 39.2 R: 16 Race

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Asked by NurseKhaphie
Patient: J.T. Weight: 250 BP: 152/88
Age: 46 yo Height: 5’7″ P: 84
Gender: Male BMI: 39.2 R: 16
Race: Hispanic   T: 97.8o

J.T. presents to the clinic today for a follow-up visit following the initiation of daily HCTZ, 12.5mg, three weeks ago for essential hypertension. As his Nurse Practitioner, you diagnosed him with Stage 2 Hypertension because his BP on his last three visits had revealed a systolic pressure over 150 and lifestyle measures had not been successful in lowering his BP readings at home or in the office. He also has a significant family history of HTN, cardiovascular disease and type II DM. The patient states that he took the medication for one week but then started noticing that he was breaking out in a pruritic rash on his arms and chest. Since this medication was the only medication he was taking, he decided it was most likely a drug reaction and stopped taking the medication. The rash subsided within 24 hours of stopping the medication. He has now returned to the clinic for the follow-up appointment that was previously scheduled and will need another medication prescribed to treat his hypertension. Additionally, you note that at his last visit, labs were drawn and his lipid profile was abnormal (See results below). You will now need to consider treating for hyperlipidemia as well. 

Total Cholesterol: 305
Triglycerides: 273
HDL: 38
LDL: 198

You are the Nurse Practitioner treating this patient.

What pharmacologic treatments would you now prescribe for this patient with the diagnoses of hypertension and dyslipidemia? (Please be specific and choose one medication for each diagnosis and give a rationale as to why you chose that particular medication.)
What is J.T.’s 10-year and lifetime ASCVD risk? 
What criteria would you be looking for in J.T.’s follow-up appointments that would lead you to intensify the dosage of the medication or add additional medications for this patient with hypertension and dyslipidemia?
What are your goals for J.T.’s blood pressure levels and his lipids? Give a rationale as to why you chose these goals.
What are the specific nonpharmacologic interventions that J.T. needs to continue to be aware of to help lower his BP and lipids?

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