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Robert is a 65-year-old African-American man who was referred to the hypertension clinic for evaluation of high blood pressure (BP) noted on an initial screening. On physical exam, his BP readings are 145/90 mm Hg and 141/96 mm Hg. He was diagnosed with diabetes 10 years ago, has a history of gout, and currently smokes 2 packs of cigarettes per day. His current medications include metformin 1,000 mg twice daily, aspirin 81 mg daily, allopurinol 300 mg daily, and rosuvastatin 20 mg daily.
Laboratory findings
Total cholesterol: 201 mg/dL
High-density lipoprotein cholesterol: 30 mg/dL
Low-density lipoprotein cholesterol: 142 mg/dL Triglycerides: 167 mg/dL
What would you consider first-line pharmacological treatment for the patient and why? What would a prescription order for the treatment look like? Please provide rationale for your choice of treatment. List one or two adverse effects to the therapy you recommended in question #1. Are there any adverse effects that would cause you to change therapy, if so, please explain? If your first-line agent were unsuccessful or a significant adverse drug event occurred, what would be your second-line pharmacological treatment for the patient and why? Please write the order for the treatment as a prescription. Please provide rationale for your choice of treatment.Discuss specific patient education based on both first- and seond-line choices.
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