Treatment of Hypertension and Diabetes
A 38-year-old male with past medical history of hypertension and diabetes. He was taken metformin 850mg 3x daily and hydrochlorothiazide 50mg daily, but his numbers continued to climb. He came to the clinic, and you decided to prescribe the following? Please use the following to answer the questions. Thanks
Lisinopril/hydrochlorothiazide and glipizide/metformin are my choices for the second line therapy.
o Would you prescribe any medications at this point? Why or why not? If so, what?
o What would be the choice for second-line therapy?
o What are the parameters for monitoring success of the therapy?
o Discuss specific patient education based on the prescribed therapy.
o List one or two adverse reactions for the selected agent that would cause you to change therapy.
o What would be the choice for second-line therapy?
o What lifestyle changes would you recommend for this patient, in addition to medication?
o Describe one or two drug–drug or drug–food interactions for the selected agent.
Treatment of Hypertension and Diabetes
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Treatment of Hypertension and Diabetes
The co-occurrence of hypertension and diabetes poses more health risks to individuals hence the need for proper management of the two conditions. According to Boer, et al. (2017), co-occurrence of hypertension among diabetic patients increases the risks of heart failure, atherosclerotic cardiovascular disease, and microvascular complications. There are several medications that can be used to manage each condition and promote overall health.
For the 38-year-old man who has been taking metformin and hydrochlorothiazide (HCTZ), I would prescribe different medications at this point because the ones he has been taking are not working. According to Yu and Kim (2016), when patients have diabetes that is not controlled using metformin, it is advisable to add another medication, such as sulfonylureas, to help maintain the numbers within the normal range. The same applies to hypertension such that if monotherapy is not working, it is advisable to prescribe a combination therapy to manage the blood pressure. I would, therefore, give the patient a combination therapy for each condition to bring his numbers down. These medications would also be the second-line therapy.
Specifically, I would combine lisinopril with HCTZ as the second-line therapy to manage hypertension and glipizide with metformin as the second-line therapy to manage diabetes. Combination therapy of lisinopril and HCTZ has been found to be effective in balancing the effects on serum potassium of angiotensin-converting enzyme (ACE) inhibitors and thiazide diuretics (Salam, et al., 2020). It is therefore an effective combination therapy in managing hypertension. When used in combination with metformin, glipizide, a second-generation sulfonylurea, is effective in reaching the recommended blood glucose levels among patients with inadequate metabolic control (Correa, Rodriguez, & Nappe, 2021). This therapy will help regulate the patient’s blood glucose level.
To monitor the success of the therapy, I would examine the patient’s numbers for both blood pressure and blood glucose. Specifically, I would monitor the blood pressure levels during the course of treatment. I would also examine fluid status to examine the volume of blood (Sukalo, et al., 2016). It is also recommended to examine serum potassium levels, especially among patients taking ACE inhibitors such as lisinopril (Boer, et al., 2017). In addition to monitoring the blood pressure, I would also monitor the blood glucose levels. A decline in the numbers of both to the desirable/normal level would be an indication that the therapy is working and vice-versa.
Specific patient education would be aimed at enhancing compliance with both pharmacological and non-pharmacological interventions. First, I would inform the patient of the dosage and mode of administration of the therapy. I would also educate them on the importance of taking the prescribed therapy, in combination with the recommended lifestyle changes. According to Shaikh (2017), this promotes compliance with medication, thus enhancing the management of the condition. Further, I would educate the patient on how to best monitor his blood pressure and blood glucose levels at home. S...