Cardiovascular Case Study

A 76-year old woman with hypertension, peripheral artery disease, Hyperlipidemia, and lower extremity edema visits her PCP. Her major complaint is her high blood pressure (BP) and some associated fatigue. Her systolic blood pressure (SBP) ranges from 140 to 200 mm Hg and diastolic BP ranges from 70 to 104 mm Hg when measured at home. She is 5’2” and weighs 175 pounds. Her body mass index (BMI) is 32 and her waist circumference is 36”. She is afebrile with a pulse of 70. Her BP is elevated in the office at 160/84 mm Hg, even with repeated readings.

ROS:

Constitutional: Reports mild weight gain, moderate fatigue
Respiratory: Dyspnea with exertion
Cardiovascular: Reports LE pedal edema

Meds:

  • Metoprolol XL 50 mg twice a day
  • Furosemide 40 mg once a day
  • Olmesartan 20 mg every bedtime
  • Clonidine 0.2 mg 4 times a day and as needed
  • Aspirin 81 mg once a day
  • Clopidogrel 75 mg once a day
  • Ezetimibe 10 mg/simvastatin 40 mg once a day

Despite these medications, her BP remains elevated. She adheres to her diet but admits to indulging at times. She also complains of bouts of headaches and some facial redness, both of which signal an acute rise in BP, for which she takes clonidine 0.2 mg 4 times a day and as necessary for relief. She goes on to relate that she has been doing some reading on supplements and vitamins and is interested in taking garlic supplements, omega-3 fatty acids, and Vitamin E. She says that garlic supplements claim to lower blood pressure, omega-3 fatty acids have anti-inflammatory properties and Vitamin E is good for the heart among other benefits.

Question answers should be based on evidence found in readings and from peer-reviewed literature. At least two sources must be used and cited in APA format for each question. Only one source can be a textbook. Resources should generally be within 5 years unless you are explaining the pathophysiology of a disease or providing pertinent background information

Discussion Questions:

  1. Review factors that affect blood pressure control with age, and explain from a pathophysiology standpoint what could be contributing to the ongoing issues with hypertension. 
  2. Explain the four factors that affect cardiac output and that impact on blood pressure control.
  3. What impact does her other medical conditions potentially have on the blood pressure control? Support with evidence while discussing these pathologies.

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