Mr. H, a 58-year-old black bank president, is admitted to the hospital with a blood pressure of 210/140. He was diagnosed with hypertension 5 years ago, and medications prior to admission included propranolol and hydralazine, although he admits that he has not faithfully taken his medications. Mr. H is 57 tall and weighs 190 pounds. The bank has just undergone a major audit, and several problems were identified. He has been working overtime and eating a lot of “fast foods” to try to keep his energy level up. He reports early morning headaches and excessive fatigue to the point that he just cannot exercise anymore. He smokes one pack of cigarettes a day and has an occasional beer. His father had a heart attack and died at 58 years of age. He has a brother and sister who both have hypertension. (Learning Objectives: 2, 3, 4, 7, 13, 16, 18, and 19)
What is hypertension? According to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), how is blood pressure classified? What are some modifiable and nonmodifiable risk factors for HTN? What are Mr. H’s risk factors? Differentiate between primary and secondary HTN. What are some possible consequences of poorly controlled HTN?