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PATHWAY-2 Right Treatment

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Written By: 
Marilyn L. Mootz, PharmD Candidate (2017) and Lucas G. Hill, PharmD, BCPS - The University of Texas at Austin

Introduction

Resistant hypertension (RH) is frequently encountered in primary care and a significant clinical challenge.  After a combination of 3 or 4 guideline-recommended treatments have been used, it remains unclear what the next best “add on” treatment for RH should be.  The recently published PATHWAY-2 study provides some evidence.  Read the iForumRx commentary.

 

Case Presentation:

HL is a 57 year-old Caucasian male who presents to your clinic for comprehensive medication management by referral from his primary care provider. He has no major complaints. The patient experiences intermittent headaches but denies chest pain, shortness of breath, dyspnea on exertion, and symptoms of orthostatic hypotension. He has decreased his intake of salt and exercises 30-minutes, 5 days per week. His medications have been filled on time for the past 1 year. The patient checks his home blood pressure in the morning before breakfast on a somewhat regular basis. He brings his home cuff to his visit and demonstrates appropriate technique.

 

PMH:

  • Hypertension x 12 years
  • Diabetes mellitus type 2 x 3 years
  • Benign prostatic hyperplasia
  • Gout
  • Osteoarthritis

FH/SH:

●Non-contributory

 

Medications:

  • Valsartan/hydrochlorothiazide 320-25 mg PO once daily
  • Amlodipine 10 mg PO once daily
  • Metformin 1000 mg PO twice daily
  • Tamsulosin 0.4 mg PO once daily after breakfast
  • Allopurinol 200 mg PO daily
  • Acetaminophen 500 mg PO as needed for pain and headache

 

Allergies: NKDA

 

Blood Pressure Readings:

6/1/15  (clinic)

148/88

12/5/15 (clinic)

145/87

1/2/16 (home)

152/92

1/8/16 (home)

150/92

1/12/16 (home)

146/88

1/17/16 (home)

150/86

1/18/16 (home)

142/92

1/19/16 (home)

150/90

1/21/16 (home)

143/85

 

Vitals/Lab values:

BP: 146/85 (sitting, clinic BP cuff) 148/86 (sitting; home BP cuff, in office)

FPG: 97

A1c: 6.8%

Weight: 87 kg

Height: 6’1”

Pulse: 80 bpm (regular)

RR: 18/min

Temp: 37 degrees C

Uric acid: 5 mg/dL

CrCl: 70 mL/min

Lab values are WNL

 

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