Hypertension Management in a 50-Year-Old Patient

by | Mar 9, 2025 | Medical

 

 

Patient Profile:

Age: 50
Gender: Male
Height/Weight: 59, 230 lbs
Medical History: Hypertension (diagnosed 3 years ago), Type 2 Diabetes (well-controlled with metformin), elevated cholesterol
Current Medications: Metformin 500 mg BID, Atorvastatin 20 mg daily
Blood Pressure: 160/98 mmHg
Instructions for Students:

Assess the patients current medications and identify potential interactions.
Recommend a pharmacologic treatment plan for hypertension. Consider first-line and alternative medications.
Justify your medication choice based on patient history and current guidelines.
Discuss any adjustments needed in the patients other medications (e.g., statins, diabetes medications) if new drugs are introduced.
Monitor: List parameters for monitoring the efficacy and safety of the chosen therapy (e.g., BP, kidney function, side effects).
Counsel: Create patient education points focusing on medication adherence, lifestyle changes, and potential side effects.

Sample solution

Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell. 

In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.


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God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.

Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.

To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.

 

References

Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.

Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.

Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.

This patient presents with uncontrolled hypertension, despite existing medications, and has significant comorbidities (Type 2 Diabetes, hyperlipidemia) that must be considered when recommending a pharmacologic treatment plan.

1. Assessment of Current Medications and Potential Interactions:

  • Metformin:
    • Generally safe and well-tolerated.
    • No significant interactions with atorvastatin.
  • Atorvastatin:
    • Generally safe and well-tolerated.
    • Potential for interactions with certain antihypertensive medications that are metabolized by the cytochrome P450 system (e.g., some calcium channel blockers). Requires monitoring.

This patient presents with uncontrolled hypertension, despite existing medications, and has significant comorbidities (Type 2 Diabetes, hyperlipidemia) that must be considered when recommending a pharmacologic treatment plan.

1. Assessment of Current Medications and Potential Interactions:

  • Metformin:
    • Generally safe and well-tolerated.
    • No significant interactions with atorvastatin.
  • Atorvastatin:
    • Generally safe and well-tolerated.
    • Potential for interactions with certain antihypertensive medications that are metabolized by the cytochrome P450 system (e.g., some calcium channel blockers). Requires monitoring.
  • Hypertension, Diabetes, and Hyperlipidemia:
    • These conditions often coexist and increase cardiovascular risk.
    • Hypertension and diabetes can lead to renal impairment, necessitating careful monitoring of kidney function.
    • The uncontrolled hypertension increases the patients cardiovascular risk.

2. Pharmacologic Treatment Plan for Hypertension:

Given the patient’s significantly elevated blood pressure (160/98 mmHg), combination therapy is warranted.

  • First-line:
    • An ACE inhibitor or an ARB is highly recommended due to the patient’s diabetes, as these medications have renal protective effects.
    • A thiazide diuretic is a good addition to the ACE/ARB.
    • A dihydropyridine calcium channel blocker (like amlodipine) would also be a good choice.
  • Rationale:
    • ACE inhibitors/ARBs: Reduce blood pressure and provide renal protection in diabetic patients.
    • Thiazide diuretics: Effective in lowering blood pressure and synergistic with ACE inhibitors/ARBs.
    • Calcium channel blockers: Effective in lowering blood pressure, especially systolic blood pressure.
  • Recommended Combination Therapy:
    • Lisinopril 20 mg daily (ACE inhibitor) and Hydrochlorothiazide 25 mg daily (thiazide diuretic).
    • Alternatively, Losartan 50mg daily (ARB) and Amlodipine 5mg daily (Calcium Channel Blocker).

3. Adjustments to Other Medications:

  • Atorvastatin:
    • No immediate adjustments are necessary.
    • If a calcium channel blocker is added, monitor for potential interactions.
  • Metformin:
    • No adjustments are necessary.
  • Monitoring Renal Function:
    • Essential due to diabetes and hypertension, and because some antihypertensive medications are renally cleared.

4. Monitoring:

  • Blood Pressure:
    • Regular monitoring (at home and in clinic).
    • Target BP: <130/80 mmHg.
  • Kidney Function:
    • Serum creatinine and eGFR (estimated glomerular filtration rate) periodically.
  • Electrolytes:
    • Potassium levels, especially with thiazide diuretics.
  • Lipid Profile:
    • Cholesterol levels periodically to ensure atorvastatin effectiveness.
  • Blood Glucose:
    • Continue monitoring for diabetes control.
  • Side Effects:
    • Dizziness, lightheadedness, cough (with ACE inhibitors), edema (with calcium channel blockers).

5. Patient Education:

  • Medication Adherence:
    • Take medications as prescribed; do not stop without consulting a healthcare provider.
  • Lifestyle Modifications:
    • Diet: DASH diet (Dietary Approaches to Stop Hypertension) or low-sodium diet.
    • Exercise: Regular physical activity (at least 30 minutes most days).
    • Weight Loss: Gradual weight loss if applicable.
    • Stress Management: Techniques like deep breathing or meditation.
    • Limit alcohol consumption.
    • Smoking cessation (if applicable).
  • Potential Side Effects:
    • Explain common side effects and management.
    • Report any unusual or concerning symptoms.
  • Blood Pressure Monitoring:
    • How to monitor at home and keep a log.
  • Follow-up:
    • Regular appointments to monitor BP, medication effectiveness, and address concerns.
    • Regular blood work.

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