Case Study: 45-Year-Old African American Male on Bisoprolol for Hypertension (Solved)

NURS-6521 Week 4 Assignment Walden University – SCENARIO 3

ES is a 45-year-old African American male that was prescribed bisoprolol for his high blood pressure. Blood pressure today is 142/89 HR 60 RR 15. He states that he only occasionally takes the medication because he does not like the side effects. What information would you provide to the patient at his visit? What is his goal blood pressure? How is hypertension treated per current guidelines (JNC 8, ACC, AHA)? How would you improve his treatment? Include a complete medication order.

SOLVED Scenario 3: Hypertension Management in African American Male

Managing ES, a 45-year-old African American male with a BP of 142/89 mmHg (Stage 1 Hypertension per ACC/AHA 2017), requires addressing significant non-adherence to bisoprolol due to side effects. Non-adherence, which affects over 50% of long-term treatment patients, worsens results and causes problems. To build confidence and adherence, explain hypertension’s silent nature and long-term consequences (CVD, stroke, renal failure) while collectively addressing and evaluating his bisoprolol side symptoms (e.g., tiredness, ED).

Blood pressure goals vary per guideline. JNC 8 suggests <140/90 mmHg for those under 60. According to the ACC/AHA 2017 recommendations, persons under 65 with hypertension should aim for a treatment goal of <130/80 mmHg on medication to reduce cardiovascular risk (Carey et al., 2021). In 2023/2024, ESH aims for <130/80 mmHg for those under 65. Based on the evidence, the ACC/AHA goal of <130/80 mmHg is recommended for ES (Carey et al., 2021). African-American-effective agents are prioritized in the updated treatment strategy. Due to reduced renin levels and greater angioedema risk, ACE inhibitors/ARBs are less effective monotherapy in this population. They should be started with a thiazide-type diuretic or calcium channel blocker (CCB) (Carey et al., 2021). Bisoprolol, a beta-blocker not recommended for monotherapy in uncomplicated hypertension, should be terminated due to ES’s non-adherence and adverse effects. Start oral amlodipine (CCB) 5 mg daily. If BP remains uncontrolled, add hydrochlorothiazide (HCTZ) 12.5 mg orally in the morning. Combination treatment uses distinct MOAs for cumulative efficacy and lower dosages with fewer adverse effects; single-pill combinations improve adherence. Labs and monitoring include blood pressure, including home monitoring; kidney function (serum creatinine, eGFR), especially diuretics; electrolytes (potassium) due to hypokalemia risk with thiazides; and lipid panel and blood glucose for cardiovascular risk assessment. Take into account medication interactions: Although CCB + Thiazide combos are safe and effective, NSAIDs can lower antihypertensive effectiveness and raise BP. Grapefruit juice inhibits CYP3A4, boosting plasma amlodipine and other dihydropyridine CCB concentrations and risking hypotension and oedema. Reference Carey, R. M., Wright, J. T., Taler, S. J., & Whelton, P. K. (2021). Guideline-Driven management of hypertension. Circulation Research , 128 (7), 827–846. https://doi.org/10.1161/circresaha.121.318083