Introduction
Hypertension is known to be one of the most prevalent cardiovascular pathologies worldwide. It is defined as a sustained elevated systemic blood pressure (BP) of higher than 140/90 mm Hg (McCance & Huether, 2019). In this case, a 59-year-old African American male patient with hypertension is presented. The man’s lifestyle is relatively healthy, but his dietary sodium intake seems excessive. Since the patient is still hypertensive, his physician renewed his thiazide diuretics recipe, prescribed an ACE inhibitor, and recommended lowering his salt consumption.
Pathology: Explanation and Plan of Care
Hypertension can be either a primary or secondary pathology, and, in this case, the man likely has the former, which develops from the combination of genetic factors and unhealthy dietary choices. Excess sodium intake causes arterial stiffness and overactivation of the renin-angiotensin-aldosterone system (RAAS), the regulatory mechanism that causes water retention (Gonzalez & Ferdinand, 2020). High circulating volume leads to elevated total peripheral resistance and thus hypertension (McCance & Huether, 2019). Therefore, it is essential to reduce the circulating volume with the help of diuretics, a low-sodium diet, and ACE inhibitors that block the activation of the RAAS.
Ethnicity and Hypertension
It is known that the incidence of hypertension is higher among African Americans. Black people are usually diagnosed with hypertension earlier than their white counterparts (Gonzalez & Ferdinand, 2020). Researchers identified several single nucleotide polymorphisms such as CACNA1 and SLC24A4 associated with hypertension in African Americans (Gonzalez & Ferdinand, 2020). Moreover, sequencing of the microbiota of hypertensive black individuals showed that their gut microbes predispose them to oxidative stress and inflammation (Gonzalez & Ferdinand, 2020). Vascular damage by inflammatory mediators puts African Americans at greater risk of developing hypertension.
Systolic Hypertension
Isolated systolic hypertension (ISH) predominates among patients with high BP. The significance of addressing elevated systolic BP cannot be overestimated because it is considered an independent risk factor for cardiovascular complications and mortality (D’Elia & Strazzullo, 2018). Chronic activation of RAAS, fluid retention, arterial stiffness, and pro-inflammatory state lead to ISH (D’Elia & Strazzullo, 2018). It appears that this patient’s genetics and dietary choices seem to activate all of these mechanisms.
Risk of Heart Failure
This patient seems to be at an increased risk for developing left heart failure (HF), which can be systolic or diastolic. The former occurs due to intrinsic cardiac problems, while the latter is caused by myocardial hypertrophy induced by a chronic hypertensive state (McCance & Huether, 2019). This man’s risk factors for hypertension and HF are being male, black, and consuming excessive salt. Since the patient does not have any heart problems, systolic HF is unlikely. Thus, this person may develop diastolic HF because of poorly-controlled BP.
Mechanism of Action of Drugs
The patient was prescribed a thiazide diuretic and an ACE inhibitor that should help control his BP. Thiazide diuretics act on the ascending Loop of Henle, blocking chloride and sodium reabsorption (McCance & Huether, 2019). ACE inhibitors prevent the ACE enzyme from converting angiotensin I to angiotensin II (McCance & Huether, 2019). Hence, adrenal glands do not receive the signal to produce aldosterone, which increases sodium reabsorption in the kidneys. Increased diuresis and reduced sodium retention decrease circulating volume and total peripheral resistance, lowering BP.
Patient-Care Technologies
Telehealth and remote BP monitoring can help control this patient’s adherence to the treatment protocol. Indeed, telemonitoring was found to be beneficial for clinicians to quickly contact patients to determine possible causes of BP alteration and suggest a prompt intervention (Lee et al., 2022). Overall, remote BP control should be able to show if the patient follows a low-salt diet and takes the prescribed medications regularly.
Conclusion
The patient, in this case, has hypertension due to such risk factors as the black race, male gender, and increased salt consumption. Considering this person’s ethnicity, the doctor prescribed a thiazide diuretic and an ACE inhibitor to block fluid retention through renal sodium-chloride channels and stop RAAS activation. Furthermore, he was recommended to lower his dietary sodium intake. Lastly, it will be helpful to apply telemonitoring to this case to track sudden BP changes.
References
D’Elia, L., & Strazzullo, P. (2018). Excess body weight, insulin resistance, and isolated systolic hypertension: Potential pathophysiological links.High Blood Pressure & Cardiovascular Prevention, 25(1), 17-23. Web.
Gonzalez, C.M., & Ferdinand, K. C. (2020). Update on hypertension in African-Americans.Progress in Cardiovascular Diseases, 63(1), 33-39. Web.
Lee, N. S., Anastos-Wallen, R., Chaiyachati, K. H., Reitz, C., Asch, D. A., & Mehta, S. J. (2022). Clinician decisions after notification of elevated blood pressure measurements from patients in a remote monitoring program.JAMA Network Open, 5(1), 1-11. Web.
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby.