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A 50-year-old obese black man arrives at your clinic with persistent elevated blood pressure of 160/95. He has had hypertension for 7 months. Despite attempts at lifestyle management, his blood pressure has continued to rise. He was started on a regimen of antihypertensive medication 1 month ago and has returned to the clinic today for a follow-up visit. His blood pressure is higher than it was initially at 175/100.
1. What other history and physical examination data should you obtain to analyze this case more effectively?
2. When and how long should lifestyle modifications alone be encouraged?
3. How long does it take for various medications to be effective?
4. What diseases worsen hypertension?
5. What psychosocial factors affect compliance with or adherence to a treatment regimen?
6. What modifications in the pharmacologic treatment plan, if any, would be most appropriate at this time?
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