Case Study: Pearls in Hypertension Pharmacotherapy

BACKGROUND: Research and therapy only has relevance when applied to an actual patient. OBJECTIVES: To review a case study of a patient with hypertension and diabetes. SUMMARY: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) of 2004 recommends that a diagnostic workup include an assessment of risk factors and comorbidities using history, physical exam, and laboratory parameters. The presence of comorbidities influences drug selection. Patient evaluation should also include identification of possible causes of hypertension, such as renal arterial stenosis, and an assessment for the presence of target organ damage. Treatment is always influenced by the presence or absence of comorbidities. Lifestyle modifications are crucial to enhancing the success of pharmacologic therapy and should be ongoing. If lifestyle modifications do not work, the clinician must consider drugs. Study data and JNC 7 recommend beta-blockers for hypertension in patients with compelling indications, e.g., high risk for cardiovascular disease and diabetes. CONCLUSIONS: JNC 7 emphasizes that evaluation for hypertension includes the assessment for the presence of compelling indications, e.g., diabetes, hyperlipidemia, and high coronary risk. These comorbidities may inform and direct pharmacologic choices.