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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Distinguish a hypertensive urgency from a hypertensive emergency.

  • Identify treatment goals for a patient with a hypertensive crisis.

  • Develop an appropriate treatment plan for a patient with a hypertensive crisis.

  • Describe how a pharmacist can educate a patient about hypertension (HTN) and the importance of providing this education.

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PATIENT PRESENTATION

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Chief Complaint

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“I’m having trouble seeing, and my chest feels tight.”

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HPI

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Brenda Flores is a 63-year-old Hispanic woman who was admitted to the emergency department with a chief complaint of difficulty seeing and chest tightness. She describes “blurry vision” that has been happening off and on for the last few days. At first, it would just last for a second or two and then go away, but it has become progressively more lingering. She initially attributed this to her eyes “just getting old” but now is more concerned that it may be something else. The chest tightness started yesterday and was initially very mild, occurring when she would walk her dog outside and resolving readily with rest. However, it has since gotten more troublesome and is limiting her daily activities. While the chest discomfort still improves with rest, it no longer completely resolves. She tried to self-medicate by taking a double dose of ranitidine last night and another dose this morning, but she says that didn’t help. She also states that this discomfort is very different from her gastroesophageal reflux. While seated in the emergency department she describes the chest discomfort as a 2 on a scale of 1–10 (highest). She has a past medical history significant for HTN and gastroesophageal reflux. She had been taking lisinopril and hydrochlorothiazide for several years with good blood pressure control, but about 6 months ago she stopped taking both medicines, because she had to make an urgent trip to visit her daughter out of state and ended up staying with her for a couple of months. Since her daughter lives in a rural area with no pharmacy nearby, she never got the medications refilled when she ran out. After several days, Ms Flores noticed that she felt just fine despite not taking the medicines. Consequently, she never resumed them and has not seen her provider since.

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PMH

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  • HTN × 9 years

  • Gastroesophageal reflux × 11 years

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FH

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Both parents had HTN. Father had a heart attack in his early 60s and died in his late 70s of a second heart attack; mother died a few years later from a stroke. Two brothers, 59 and 62 years old, are both alive; the elder has HTN and hypercholesterolemia and underwent CABG surgery 3 years ago; the younger has no chronic diseases. One sister who is 55 years old is in fairly ...

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