Ecivon - Hypertension Patient Case (TM)

Thomas McEwan is a 51 year old black male diagnosed with hypertension 7 years ago. Thomas visits your pharmacy and enrolls in your hypertension care program. You are to work with Tom to manage his hypertension and prevent complications.

To communicate with Thomas, send him an e-mail at: t-mcewan@onu.edu

CC: "I've been getting headaches lately. I lost my job as a machinist and as old as I am, I am not ready to try and find a new job".

HPI: TM is a 51-year-old African American man with a seven year history of HTN.

PMH: HTN; Bilateral Renal Arterial Stenosis (RAS).

FH: Divorced, 1 unmarried child, mother deceased ~ 10 yrs ago of unknown cause, father (83 years old), w/a, h/o CABG x 3, DM2.

SH: + tobacco use; 1-2 packs a day for 35 years, + EtOH (social), (-) exercise, diet consists of food prepared at work and mostly prepackaged or canned foods at home.

Meds: NPH insulin 8 units AM and PM, Regular insulin 2 units before each meal, Multivitamin 1 QD, Neurontin 100 mg TID, Furosemide 40 mg 1 PO QD.

ALL: Fish

PE:

Gen: WD, mildly obese, BM in NAD; 5'11", 193lbs, BP 200 mmHg/100 mmHg, HR 85

HEENT: NC/AT, EOMI, PERRLA, (-) JVD, nasopharynx clear

CV: S1, S2, regular

Lungs: + bilateral BS, no RRW

Abdomen: + BS, NT, central obesity

Ext: (-) C/C/E

Neuro: A and O X 3/3, strength 5/5

Laboratory Results

Lab	Value
Na⁺ (mEq/L)	143
K⁺ (mEq/L)	4.2
Cl^- (mEq/L)	108
CO₂ (mEq/L)	27
BUN (mg/dL)	22
SCr (mg/dL)	2.5
Glucose (mg/dL)	142
A1C (HbA₁C)%	9.5

Urine dipstick: + protein, + glucose

Ultrasound: No obstruction of the ureters

About the Authors

David F. Kisor, B.S., Pharm.D.
Email: d-kisor@onu.edu

Dave Kisor is Chair of the Department of Pharmaceutical and Biomedical Sciences and Associate Professor of Pharmacokinetics at the Ohio Northern University College of Pharmacy.

Jon E. Sprague, Ph.D.
Email: j-sprague@onu.edu

Jon Sprague is Dean and Professor of Pharmacology at the the Ohio Northern University College of Pharmacy.