Question

You are caring for a 59-year-old African American male who is a non-smoker and a non-drinker. The individual has a healthy weight for his height. On weekends, he coaches a youth baseball team in his community and enjoys eating hot dogs and nachos with the children after games. He has been monitoring his blood pressure at the community center and noted that the highest reading was 168/92 mm Hg. He is pleased with this number, as the results were "lower than previous readings." However, his healthcare provider is still concerned. She informed him about the dietary choices he was making and reminded him to limit his sodium intake. She also renewed the individual's prescription for a thiazide diuretic and added an ACE inhibitor to his treatment regime.

Please answer the following prompts in your analysis of the case:

Speculate how the individual's ethnicity contributes to his hypertension. Discuss other determinants of health that contribute to the prevalence of hypertensive disease in this population.

Discuss the significance of an elevated systolic pressure, even in the absence of diastolic hypertension, detailing the pathophysiology behind elevation in blood pressure and the ultimate development of hypertension.

Identify if this individual is at risk for developing heart failure. If so, what type of heart failure would he be most at risk of developing?

Briefly discuss the mechanism of action of the two classes of drugs this individual was prescribed for the management of his hypertension.

Answer 1

Hypertension affects the African-Americans’ at a very younger age compared to other ethnic groups in the U.S. The complications associated with hypertension re also very common in this ethnic group. The most common complications associated with hypertension are heart diseases, dementia, stroke and renal disorders.

The determinants which contribute to the high hypertension prevalence are genetic factors and environmental factors.

Genetic factors contributing to the high rates of hypertension in African-Americans can be their increased sensitivity to salt and their different response to anti-hypertensive drugs.

Environmental factors such as the overnutrition, social distress and inequality can contribute to the problem. Studies prove that 41% of blacks have high blood pressure in comparison with 27% of whites in the US.

The risk factors of hypertension in African- Americans are obesity, family history, risk increases with age, diabetes mellitus, physical inactivity, high intake of dietary salt and fat, smoking, decreased potassium in the diet.                                                                                                                   

Pathophysiology:

The risk factors may cause a change in arteriolar bed and thereby increases the systemic vascular resistance that can cause an increase in afterload and which in turn reduces the blood flow to the organs. The resultant decrease in renal perfusion will again contribute to increasing the release of angiotensin converting enzymes by stimulation of juxtaglomerular cells and thereby increased the release of renin. The resultant stimulation of adrenal cortex, in turn, increases the aldosterone which effects the retention of sodium and water and adds to hypertension. The increased blood pressure of the vascular system and arteriolar vasoconstriction increases the peripheral vascular resistance.

Left ventricular hypertrophic heart failure occurs in people with hypertension.

ACE inhibitors cause vasodilation by inhibiting the formation of angiotensin II. And there by reduces the pressure.

Thiazide diuretics control hypertension by inhibiting reabsorption of sodium (Na+) and chloride (Cl?) ions from the distal convoluted tubules of the kidneys by blocking the thiazide-sensitive Na+ and Cl? symporter.