Management Plan for Primary hypertension

Management Plan for Primary hypertension with at least 3 scholar resources

Use the above diagnosis provided to create a pertinent, comprehensive, evidenced-based management plan.

Address the following criteria in the plan:

1.) Diagnostic tests;

2.) Medications (write out a complete order, even for OTC meds);

3.) Suggested consults/referrals;

4.) Patient education;

5.) Follow-up, including time interval and specific symptoms to prompt a return visit sooner;

6.) Provide rationales for each intervention and include references to support your plan. Clinical practice guidelines should be utilized as applicable.

Management Plan for Primary Hypertension

Diagnostic Tests

1. Blood Pressure Measurement:
   • Rationale: Regular BP measurement is essential for diagnosing and monitoring hypertension.
   • Reference: Whelton, P. K., et al. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension, 71(6), e13-e115.
2. Electrocardiogram (ECG):
   • Rationale: To check for cardiac abnormalities or left ventricular hypertrophy that may result from prolonged hypertension.
   • Reference: Aro, A. L., et al. (2014). Electrocardiographic left ventricular hypertrophy and outcome in hypertensive patients. Journal of Hypertension, 32(2), 438-444.
3. Basic Metabolic Panel (BMP):
   • Rationale: To assess kidney function, electrolyte levels, and blood glucose levels, as hypertension can affect these parameters.
   • Reference: Taler, S. J. (2014). Initial treatment of hypertension. New England Journal of Medicine, 371(9), 798-799.
4. Lipid Profile:
   • Rationale: To evaluate the patient’s risk for cardiovascular disease.
   • Reference: Stone, N. J., et al. (2014). 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. Journal of the American College of Cardiology, 63(25 Part B), 2889-2934.

Medications

1. Lisinopril 10 mg PO daily:
   • Rationale: ACE inhibitors are first-line therapy for hypertension; they help relax blood vessels and reduce blood pressure.
   • Reference: Whelton, P. K., et al. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension, 71(6), e13-e115.
2. Hydrochlorothiazide 25 mg PO daily:
   • Rationale: Thiazide diuretics are often used in combination with ACE inhibitors for better blood pressure control.
   • Reference: James, P. A., et al. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults. JAMA, 311(5), 507-520.
3. Aspirin 81 mg PO daily:
   • Rationale: Low-dose aspirin may be considered for cardiovascular protection in patients with elevated risk.
   • Reference: Gaziano, J. M., et al. (2018). Aspirin for primary prevention of cardiovascular events in people with diabetes. New England Journal of Medicine, 379(16), 1529-1539.

Suggested Consults/Referrals

1. Referral to a Cardiologist:
   • Rationale: For comprehensive cardiovascular risk assessment and management if there are complications or secondary causes of hypertension.
   • Reference: Mancia, G., et al. (2013). ESH/ESC Guidelines for the management of arterial hypertension. European Heart Journal, 34(28), 2159-2219.
2. Referral to a Dietitian:
   • Rationale: To provide dietary counseling, particularly regarding the DASH diet, which has been shown to reduce blood pressure.
   • Reference: Sacks, F. M., et al. (2001). Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. New England Journal of Medicine, 344(1), 3-10.

Patient Education

1. Lifestyle Modifications:
   • Diet: Emphasize the DASH diet, rich in fruits, vegetables, and low-fat dairy products.
   • Exercise: Encourage at least 150 minutes of moderate-intensity aerobic activity per week.
   • Weight Management: Advise weight loss if the patient is overweight or obese.
   • Smoking Cessation: Strongly recommend quitting smoking and provide resources for support.
   • Rationale: These lifestyle changes have been proven to significantly lower blood pressure and improve overall cardiovascular health.
   • Reference: Appel, L. J., et al. (1997). A clinical trial of the effects of dietary patterns on blood pressure. New England Journal of Medicine, 336(16), 1117-1124.

Follow-Up

1. Follow-Up Visit in 4 Weeks:
   • Rationale: To assess the effectiveness of the medication regimen and make any necessary adjustments.
   • Reference: Whelton, P. K., et al. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension, 71(6), e13-e115.
2. Immediate Return if Experiencing:
   • **Severe headache, dizziness, chest pain, shortness of breath, or any other concerning symptoms.
   • Rationale: These symptoms could indicate hypertensive emergencies or adverse reactions to medications.
   • Reference: Chobanian, A. V., et al. (2003). Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension, 42(6), 1206-1252.

References

1. Whelton, P. K., et al. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension, 71(6), e13-e115.
2. Aro, A. L., et al. (2014). Electrocardiographic left ventricular hypertrophy and outcome in hypertensive patients. Journal of Hypertension, 32(2), 438-444.
3. Taler, S. J. (2014). Initial treatment of hypertension. New England Journal of Medicine, 371(9), 798-799.
4. Stone, N. J., et al. (2014). 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. Journal of the American College of Cardiology, 63(25 Part B), 2889-2934.
5. James, P. A., et al. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults. JAMA, 311(5), 507-520.
6. Gaziano, J. M., et al. (2018). Aspirin for primary prevention of cardiovascular events in people with diabetes. New England Journal of Medicine, 379(16), 1529-1539.
7. Mancia, G., et al. (2013). ESH/ESC Guidelines for the management of arterial hypertension. European Heart Journal, 34(28), 2159-2219.
8. Sacks, F. M., et al. (2001). Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. New England Journal of Medicine, 344(1), 3-10.
9. Appel, L. J., et al. (1997). A clinical trial of the effects of dietary patterns on blood pressure. New England Journal of Medicine, 336(16), 1117-1124.
10. Chobanian, A. V., et al. (2003). Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension, 42(6), 1206-1252.