Continuation with the last project./women health(menopause).

How do your antihypertensive recommendations compare to JNC8 guidelines?

Case Study
Patient Health Needs

In the clinical scenario, the patient is a 46 year-old female, obese and hypertensive and is
currently on amlodipine with hydrochlorthiazide for treatment of hypertension. On follow up,
she presented with a blood pressure of 150/90 with symptoms of hot flushing, night sweats, and
genitourinary symptoms. Her healthcare needs include investigation of her current symptoms,
modification of pharmacotherapy for hypertension, and pharmacotherapy with counselling for
hypertension and obesity. Further history taking and examination should be performed in order
to evaluate symptoms of hot flushing, night sweats, and genitourinary symptoms. However, these
are common side effects of her current anti-hypertensive regimen (Rosenthal & Burchum, 2018).
According to the recommendations of the US Preventive Services Task Force (USPSTF) (2019),
she necessitates Pap’s smear every 3 years for cervical cancer prevention, and genetic counselling
and pharmacotherapy for prevention of breast cancer.

Recommended Treatment Regimen and Patient Education
Hot flushes and night sweats are known side effects of Norvasc (Burchum and Rosenthal,
2018). Because the patient’s blood pressure is poorly controlled and the patient has possible side
effects of Norvasc, she can be offered a combination treatment of enalapril 5mg and
hydrochlorthiazide 25mg to control and to discontinue Norvasc. According to the
recommendations of the American College of Cardiology, angiotensin converting enzyme
inhibitors belong to the first line of treatment for hypertension (Wheton et al, 2017). Aside from
counselling the patient regarding the recommended lifestyle modifications for blood pressure and
weight control, pharmacologic treatment options for obesity such as Orlistat, Lorcaserin, or
Liraglutide. The American Endocrine Society recommends against the use of phentermine and

WOMEN’S AND MEN’S HEALTH3

3
diethylproprion for hypertensive obese patients (Apovian et al, 2015). Due to the patient’s family
history of breast cancer, she is at high risk for development of breast cancer. The USPSTF
(2019) recommends preventive pharmacotherapy for high risk patients with Tamoxifen,
raloxifene or aromatase inhibitors. Among these agents, raloxifene is the best choice because
both tamoxifen and aromatase inhibitors can result in hot flushes and night sweats. The risks and
benefits of all treatments should be discussed with the client for well-informed decision-making.

WOMEN’S AND MEN’S HEALTH4

4

References

Apovian, C. M., Aronne, L. J., Bessesen, D. H., Mcdonnell, M. E., Murad, M. H., Pagotto, U., …
Still, C. D. (2015). Pharmacological Management of Obesity: An Endocrine Society
Clinical Practice Guideline. The Journal of Clinical Endocrinology &
Metabolism, 100(2), 342–362. doi: 10.1210/jc.2014-3415
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice
providers. St. Louis, MO: Elsevier.
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison
Himmelfarb, C., … Wright, J. T. (2018). 2017
ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the
Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.
Journal of the American College of Cardiology, 71(19), e127–e248.
doi:10.1016/j.jacc.2017.11.006 
US Preventive Services Task Force. (2019, September 3). Recommendation: United States
Preventive Services Taskforce. Retrieved April 24, 2020, from
https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-
medications-for-risk-reduction