History of hypertension, transient ischemic attack (TIA) and gout.

  A 79-year-old African American woman with a history of hypertension, transient ischemic attack (TIA) and gout. Her medications include febuxostat 80 mg/day, felodlpine 10 mg/day, benazepril 40 mg/day, and enteric coated aspirin 81 mg/day. Her vital signs include 813 145/85 mmHg and HR 82 beats/minute. What Is the best approach to improve her BP control, If anything? Please provide your answer supporting it with evidence based medicine. For extra kudos . since we have not discussed yet. Is there anything else that should be addressed in the patient?

The American Academy of Family Physicians (AAFP) recommends that pharmacologic treatment should be initiated when the systolic pressure is 140 mm Hg or higher, or when the diastolic pressure is 90 mm Hg or higher. Combination therapy is recommended for most patients, and should include a thiazide diuretic, a CCB, and an ACEI or ARB.

In addition to hypertension, the patient has a history of TIA and gout. It is important to ensure that the patient is taking the appropriate medications for these conditions and that they are being managed appropriately. The patient’s vital signs indicate that her blood pressure is not well controlled. It may be necessary to adjust her medications or add additional medications to help control her blood pressure.

Sample Solution

The American Academy of Family Physicians (AAFP) recommends that pharmacologic treatment should be

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