Peer responseLength: A minimum of 150 words per post, not including references
Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
Peer Post:Mr. Smith is a 64-year-old African American male. He was diagnosed with hypertension and hyperlipidemia 5 years ago and has not taken meds regularly for the last year. He states he has been experiencing chest pain when working around the house and sometimes while on his evening walk. He also complains that his feet are swelling in the evening. His vitals today: P-105, B/P-165/100, R-20. Wt-260 Ht-5’9” Labs: TC- 240, LDL- 145, HDL- 30, Trig-250. Sulfa allergy. You are assigned as his new PCP.
What medication recommendations will you make? Include the drug class, generic and trade name and starting dose range. Provide rationale for your choices.
Screen all patients initially for substances that can interfere with the blood pressure medications. If possible, consider altering or eliminating the substance that raises blood pressure (Unger et al., 2020). The black population develops hypertension and associated organ damage due to physiological differences, such as early vascular aging such as stiffness, altered renal sodium handling, and increased cardiovascular reactivity. It is recommended to use a single pill combination including thiazide with calcium channel blocker or calcium channel blocker with angiotensin receptor blockers (ARBS) as a first line drug of choice. Diuretics are indicated to increase water loss through the urine, decreasing the blood volume, plasma, and cardiac output, resulting in lower blood pressure. It is not preferable to use ARBS, and ace inhibitors as it can cause angioedema for black patients. Loop diuretics will be ideal for the patient since thiazide maybe contraindicated because of his allergy to sulfonamides. Common Calcium channel blockers (CCB) are Nifedipine (Procardia) 30mg – 60mg once daily, Amlodipine (Norvasc) 5mg – 10mg, which works on the smooth muscle of the blood vessel that causes dilatation and assists in blood flow, it is also indicated for angina as ischemia can cause pain when there is no enough oxygenation to the tissues (Rosenthal