Define hypertension, classification, clinical presentation and hypertensive crisis.  What stage does the patient have? What is the treatment goal? What types of complications could this patient have later, if his hypertension is not properly treated? 

YY is a 56yo African American male who works as a shipping manager for local distribution center.  He has untreated hypertension (BP readings has been elevated on the last 3 occasions).  He lives with his 10yo son.  He is divorced 5 years ago.  He experienced occasional headaches, but other than that, he said he feels “fine.”  He sleeps 4-6 hours per night on average.  His job is causing him some stress lately.  Past Medical History: anxiety, depression, diabetes mellitus

Allergies:  peanuts, Celexa (headache)

Home Medications: metformin 500mg twice daily, omeprazole 20mg daily; zolpidem 10mg qhs prn, naproxen 250mg daily prn

Family History: father deceased (stroke); mother still living in nursing home with dementia

Social History: drinks socially on weekends, smokes occasionally

Vitals: BP= 146/84 and 144/80 mmHg (right arm, sitting); HR=72 BPM; RR= 18 per minute; height= 5’10’’; weight=192 lbs.

Define hypertension, classification, clinical presentation and hypertensive crisis.  What stage does the patient have? What is the treatment goal?

What types of complications could this patient have later, if his hypertension is not properly treated?

List some modifiable risk factors and which ones are present in YY?

On the day of his visit, if his cardiac output is 5.8L/min, what would his cardiac stroke volume be?

What are some appropriate pharmacological first-line therapies that can be recommended? Discuss the guidelines for the type of antihypertensives according to JNC-8.

Discuss the drug classes of hydrochlorothiazide, benazepril, and amlodipine. Give 1-2 alternative drugs for each of them.

Discuss the renal anatomy and physiology related to the mechanism of action of hydrochlorothiazide.  Discuss the mechanism of action of hydrochlorothiazide.