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Health, Medicine, Nursing
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Case Study
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Hypertension Case Study (Case Study Sample)

Instructions:

This task was about doing the pgcert independent and supplementary prescribing for pharmacists on a patient suffering from hypertension using the information and test results given by the customer. Furthermore, the case study was to be done in observation of the nice guidelines, the uk formularies , and relevant randomised control/meta analysis.

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Content:


City, State
Hypertension Case Study
Name
Student ID
Professor’s Name
Date of Submission
Hypertension Case Study
Introduction
Due to increased demand for primary care and reduced GP manpower, new care plans have been developed with a view to treating and monitoring long-term diseases such as high blood pressure [1], [2]. Pharmacists can play a crucial role in high blood pressure care, including urging patients to comply more closely with antihypertensive therapy prescriptions and occasionally monitoring blood pressure (BP).
Hypertension is a hemodynamic illness, defined by a rise in peripheral vascular resistance that results in severe disorders for example myocardial infarction, renal failure, strokes, or even mortality if not recognised early and treated effectively [3].High BP or hypertension persistently raises the risk of cardiovascular disease [4]. Induced risk of cardio-vascular (for example heart attack), stroke and renewal events (such as renal impairment and failure) are associated with hypertension [5]. The underlying patherinological mechanisms originate from an injury to the small and big blood capillaries, which results in structural and functional alterations in the walls of blood arteries, which affect blood flow self-regulation and affect the permeability of capillary walls [6], [7].
The decrease of 22% (95% fiducies [CI]: 17-27%) in relative BP (RR) risk in BP by 10mmHg (systolic) or 5mmHg (diastolic), and 41% (95% CI:33%-48%) of the stroke RR by baseline systolic BP, by over 110mm in patients with CVD status in the preceding year, was seen in the epidemiology research [8]. Generally, systolic BP combination is greater than diastolic BP [9]; both systemically and diastolic BP elevated by cardiovascular parameters and renal disease [9], [10].
Almost one quarter of all adults, that the WHO labelled as "a worldwide health catastrophe" were afflicted by an increased prevalence of hypertension as the largest non-transmissible disease in the world [5], [11]. The 2016 Health Survey for England assessed the national prevalence of high pressure, based on BP readings by nurses in 8,011 persons (12). The data show that 28 percent of adults in Britain suffer from excessive blood pressure and 12 percent of adults remain untreated [12].In 2018, the Brit Heart Foundation predicted that saving up to £202 million and £72 million [13] respectively might save 14,500 strokes and 9,710 heart attacks in England for three years. Adjustments therefore are essential in the current healthcare system to improve high blood pressure, awareness as well as detection, treatment and follow-up.
The guideline 2019 on hypertension for diabetes under 80 percent, first established by the NICE, the English Health Technology Assessment Authority [4], and the 2011 guidelines; (14). Three phases of hypertension are classified:
* stage one: BP >140/90mmHg and AMP >135/85mmHg at home or during the day;
* Stage two: Clinical reading of the ambulatory or home-monitoring average of 160/100mmHg or above and subsequently of 150/95 mmHg or higher.
* Stage 3 or serious BP: BP 180mmHg (systolic) or 110mmHg (diastolic) or greater (14).
While specific BP limits or cut-off points are mostly arbitrary, doctors must be aware if therapies based on a predicted CVD risk can be initiated or modified [15].
Case Presentation
1 Background
The patient, in this case, will be referred to under the pseudonym "Mrs. I" [16]. This female patient was seen remotely by my DPP. We discussed it in depth and my DPP asked for my views on the case. The patient has been registered with the practice since 2019. She lived in India prior, so further history is not available. She has been assessed for secondary causes of hypertension due to being under 40 however no cause was discovered. I reviewed the patient's notes including recent test results. I then followed up on the case in two weeks in a second remote appointment shadowed by my DPP and then completed a case-based discussion on this experience.
Table 1: Patient details
Name/ Age

Mrs. I/ 36

Sex

Female

Ethnicity

Indian

Past Medical History

Essential Hypertension (diagnosed 2019), No known allergies

Social History

Non-smoker, Does not drink alcohol, and Does not use recreational drugs

Family History

Both parents alive and well, Family has a history of hypertension

Medication history

Ramipril 5mg capsule- One capsule to be taken daily.

Blood pressure Reading

150/101mmHg (May 2021)

Height
Weight
BMI

170cm
61kg
21kg/m2 (2021)

2 Subjective
Mrs. I was diagnosed with stage 1 Hypertension in 2019. She was prescribed Ramipril 5mg capsules with a dose of one capsule to be taken daily. Ramipril reduces the blood pressure of the patient and facilitates blood pumping around their heart [17]. Mrs. I had ordered their prescription for their hypertensive medication online as usual. However, as they had not come in since 2020 for a check-up due to the ongoing Covid-19 pandemic, my DPP requested a home blood pressure reading be emailed to her. The patient reported a reading of 150/101mmHg. She has no symptoms indicative of high blood pressure.
3 Objective
Mrs. I next had a home blood pressure surveillance for a period of seven days (HBPM). The readings were provided and I was requested to obtain an average reading of blood pressure. I deleted measures on the first day and utilized the average values of all subsequent measurements according to the National Institute for Health and Care Excellence (NICE) guidelines on Hypertension [14].The ensuing average HBPM was 150/97 mmHg, which is defined as Stage 2 high blood pressure according to NICE criteria [14].
The order for biochemical tests and dipstick urine to test proteinuria has been evaluated to see if there is an additional explanation for an increase in blood pressure renal function. A serum total cholesterol, HDL cholesterol measurement was required as well as a QRISK-3 assessment should also be calculated to evaluate cardiovascular risk even as Mrs. I was not on the antiplatelet or statin medication.
Table 2: Result Summary
 

Result

Normal Range

Ordering Reason

Home Blood Pressure Monitoring (HBPM)

150/97 mmHg

Clinic blood pressure <140/90mmHg1

for confirmation of stage 2 hypertension



HBPM <135/85mmHg1


Heart rate (heart beats per minutes – bpm)

70 bpm regular

60-100bpm whilst resting2

for checking of irregular pulse





Height

170cm

 

To calculate BMI

Weight

6`kg



BMI

21 kg/m2

Ideal BMI in most adults 18.5-24.9kg/m2 (3)

to access cardiovascular (CV) risk

Laboratory test results

Test

Result

Normal Range

HbA1c

40mmol/mol

<48mmol/mol(3)

Serum urate level

362micromol/L

200-420micromol/L

Renal profile

Within normal range

Serum sodium

137mmol/L

133-146mmol/L

Serum potassium

4.3mmol/L

3.2-5.3mmol/L

Serum urea level

5.1mmol/L

2.5-7.8mmol/L

Serum creatinine

78micromol/L

64-104micromol/L

eGFRcreat(CKD-EPI)/1.73m2

>90mL/min (no other markers of kidney disease present)

>90mL/min

Urine albumin: creatinine ratio

1.1mg/mmol

0-3mg/mmol

LFTs

Within normal range

Lipid profile

 

 

Serum cholesterol

3.2 mmol/L

<5 mmol/L

Serum HDL cholesterol level

1.5mmol/L

1-10 mmol/L

Serum cholesterol/HDL ratio

2.1

<4

Serum non HDL cholesterol level

1.7mmol/L

<2.5mmol/Lor at least a 40% decrease or greater from baseline if on statin therapy




The dipstick urine test to ch...

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