J. H.

CERILLES STATE COLLEGE

Pagadian City Campus
West Capitol Road, Balangasan District, Pagadian City
In consortium with
Western Mindanao State University
Zamboanga City

HYPERTENSION AS THE RISK FACTOR OF NON-COMMUNICABLE DISEASE IN THE

PHILIPPINES DUE TO FACTORS AND THE INTERVENTIONS USED BOTH
NONPHARMACOLOGIC AND PHARMACOLOGIC APPROACH

A Case Study

Presented to the Department of Nursing

In Partial Fulfilment

Of the Requirements for Pharmacology

Irish Ann M. Aglosolos, SN

Joyce Bernadette P. Andot, SN
Karen Grace R. Enggeo, SN
Dirdre Mie G. Hijastro, SN
Fauziya M. Karim, SN
Charlyn Mae C. Miro, SN
Kaye P. Panganiban, SN
Ralph Daniel R. Quiapo, SN
Yamie Bae P. Sulong, SN
CONTACT INFORMATION
Aglosolos, Irish Ann M., SN
Address: Poblacion Malangas, Zamboanga
Sibugay
Email: irishann@yahoo.com
Phone: 09071779114
Andot, Joyce Bernadette P., SN
Address: Dao, Pagadian City
Email: Dao, Pagadian City
Phone: 09365848578
Enggeo, Karen Grace R., SN
Address: Balangasan, Pagadian City
Email: karyanggrace10@gmail.com
Phone: 09997960239
Hijastro , Dirdre Mie G., SN
Address: Sta. Maria Districts, Pagadian City
Email: dirdremieh@gmail.com
Phone: 09355111335
Karim, Fauziya M., SN
Address: Labangan, Zamboanga Del Sur
Email: ziastrangeti99@gmail.com
Phone: 09358754830
Miro, Charlyn Mae C., SN
Address: Tiguma, Pagadian City
Email: mirocharlynmae@gmail.com
Phone: 09505599372
Paganiban, Kaye P.,SN
Address: Poblacion, Guipos, Zamboanga
Del Sur
Email: kayepanganiban23@yahoo.com
Phone: 09997960239
Quiapo, Ralph Daniel R.,SN
Address: Kagawasan, Pagadian City,
Zamboanga Del Sur
Email: ralphdanielq14@gmail.com
Phone: 09452008072
Sulong, Yamie Bae P.,SN
Address: Tuburan, Pagadian City,
Zamboanga Del Sur
Email: yhamiisulong@outlook.com
Phone: 091074902
 A CASE STUDY OF HYPERTENSIVE PATIENT A

I. Abstract

Hypertension is defined as persistently elevated arterial blood pressure. The classification

of BP in adults are normal, prehypertension, stage 1 and stage 2 hypertension. It is very
important to know the physiology of the disease and the factors of high blood pressure that
can give complication. Hypertension is a major cause of premature death worldwide. The
patient has hypertension associated with prediabetes because of excessive use of alcohol,
smoking, and sedentary life that lead to complications. So we decided to have a therapeutic
regimen in terms of pharmacologic and nonpharmacologic approach. We come up to the
outcomes that the patient maintains the normal physiology because he observe and apply to
its life.

II. Introduction and Patient Profile

Hypertension is a common condition in which the long-term force of the blood against
your artery wall is high enough that may eventualy cause health problems, such as heart
disease. Blood pressure is determined both by the amount of blood your heart pumps and the
amount of resistance to blood flow in your arteries. The more blood your heart pumps and
the narrower your arteries, the higher your blood pressure. You can have hypertension for
years without any symptoms. Even without symptoms, damage to blood vessels and your
heart continues and can be detected. Uncontrolled high blood pressure increases your risk of
serious health problems, including heart attack and stroke. High blood pressure generally
develops over many years, and it affects nearly everyone eventually. Fortunately, high blood
pressure can be easily detected. And once you know you have high blood pressure, you can
work with your doctor to control it. Prediabetes means that your blood sugar level is higher
than normal but not yet high enough to be classified as type 2 diabetes. Without intervention,
prediabetes is likely to become type 2 diabetes in 10 years or less. The long-term damage of
diabetes are your heart and circulatory system. The significance of this case study is to know
more about the hypertension 1 associated to prediabetes.
 Patient A, A 30 years old male with the act of sedentary life and pre diabetes presents for
his annual physical. He experienced pain on the neck, dizziness, elevated blood pressure and
discomfort to his body. The average of 2 blood pressure readings in his right arm is BP
143/88 mmHg. His physical exam is unremarkable except for obesity. He has no history of
myocardial infarction, stroke, kidney disease, or heart failure. After the visit, he measures his
blood pressure at home and returns 1 month later. The average BP from multiple clinic and
home readings is 136/86. His total cholesterol is 260 mg/dL, High-density lipoprotein 42
mg/dL, and Low-density lipoprotein 165 mg/dL. He smokes, eat more fats and drink
alcoholic beverage.

PATIENT PROFILE

A. NAME: Patient A
B. AGE: 30 years old
C. SEX: Male
D. DATE OF BIRTH: June 25, 1969
E. ADDRESS: Pagadian, Zamboanga del sur
F. ARRIVED VIA: Transportation Vehicle
G. CIVIL STATUS: Married
H. RELIGION: Roman Catholic
III. Interventions and Outcomes

Nursing Interventions

Drug Study
IV. Discussions

With stage 1 hypertension, he would benefit from a BP-lowering medication. Thiazide

diuretics, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, and
calcium channel blockers are first-line agents for hypertension because they reduce the risk
of clinical events. Patient-specific factors, such as age, comorbidities, concurrent
medications, drug adherence, and out-of-pocket costs should be considered. Shared decision
making should drive the ultimate choice of antihypertensive medication. Non-pharmacologic
strategies for prediabetes and hypertension include dietary changes such as lowering the diet
of salt and sugar intake, physical activity must be acknowledged in order to have a normalize
blood pressure since it is hypertension 1, and weight loss. If clinically appropriate, he should
also avoid agents which could elevate blood pressure, such as NSAIDs, oral steroids,
stimulants, and decongestants. A goal BP of 130/80 is recommended. After starting the new
blood pressure medication, he should monitor blood pressure at home and return to the clinic
in 1 month. If the blood pressure goal is not met at that time despite adherence to treatment,
consideration should be given to intensifying treatment by increasing the dose of the first
medication or adding a second agent. Diabetes mellitus is a major risk factor for
cardiovascular disease (CVD). Approximately two-thirds of people with diabetes die from
complications of CVD. Nearly half of middle-aged people with diabetes have evidence of
coronary artery disease (CAD), compared with only one-fourth of people without diabetes in
similar populations. Patients with diabetes are prone to a number of cardiovascular risk
factors beyond hyperglycaemia. These risk factors, including hypertension, dyslipidaemia,
and a sedentary lifestyle, are particularly prevalent among patients with diabetes. To reduce
the mortality and morbidity from CVD among patients with diabetes, aggressive treatment of
glycaemic control as well as other cardiovascular risk factors must be initiated.

Cholesterol is a fat-like (lipid-like) substance that your body uses as a building block to
produce hormones, vitamin D, and digestive juices that help you break down fatsin your diet.
HDL (high-density lipoprotein, or “good” cholesterol) and LDL (low-density lipoprotein, or
“bad” cholesterol) are two types of lipoproteins that carry cholesterol to and from the body’s
cells in the blood. The body needs some cholesterol to function, but when levels get too high,
fatty deposits can accumulate in blood vessels, which causes them to narrow. This narrowing
of the blood passageways by these lipids can lead to heart attacks, coronary artery diseas,
stroke, or other vascular diseases. Triglycerides are components found in body fat, and fats
from the foods you eat. Triglycerides show what you have recently eaten, and cholesterol
shows what you have eaten over a long period. If you eat a fatty meal, it gets absorbed as
triglycerides, so in the first few days after eating a fatty meal you will have high levels of
triglycerides in your blood. The liver then packages these triglycerides as fats in your adipose
tissue, and turns some of it into cholesterol. This leads to high cholesterol levels in the blood
for a few days to weeks after eating a fatty meal. Like cholesterol, you need some
triglycerides to keep the body healthy, but increased levels can cause health problems. LDL
and HDL are the two main types of cholesterol (blood fats, or lipids) that make up your total
cholesterol. HDL (high-density lipoproteins), or “good” cholesterol, may protect the body
against narrowing blood vessels. LDL (low-density lipoproteins), or “bad” cholesterol, may
make arterial narrowing worse. High cholesterol usually has no symptoms. That’s why it’s
important to have your doctor check your cholesterol levels. A simple blood test will shed
light on your cholesterol levels and allow you to make informed decisions about your health.
For most adults over age 20 who are not taking already cholesterol medication, you may not
need to before having this blood test this is the first time you’ve had your levels checked.
Your doctor will tell you if you should fast before your test. (Fasting means not having food,
beverages and medications.) The period of fasting before a cholesterol test is usually nine to
12 hours. In the test, a small sample of blood will be taken. If additional blood tests are
needed, all the samples are usually taken at once. Any discomfort is minor.

Nursing interventions, are very important when the patient is experiencing the process of
disease. The patient who has hypertension is encourage to avoid intake saturated fat and
cholesterol to avoid increase of blood pressure and risk of heart attack or stroke. It is referred
to DASH (Dietary Approaches to Stop Hypertension) patient must eat appropriate foods such
as diet in vegetables, fruits and low-fat dietary foods to improve health and prevent high
blood pressure. According to Mayo Clinic to reduce the sodium in your diet and eat a variety
of foods rich in nutrients that help lower blood pressure, such as potassium, calcium, and
magnesium. Exercise helps to prevent cardiovascular disease and improves circulation. It can
also make your heart stronger and lower your blood pressure. It is important for the effective
functioning of the body to make the circulatory system stronger, more flexible and more
expansive. According to Dr. Jarvis, Exercise helps circulation as it increases blood flow, gets
the heart pumping blood around your body faster and helps flush the blood through your
arteries. Selfcare can be defined as activities that a patient undertakes with the intention of
improving health or preventing disease. It also helps manage your weight and strengthen
your heart. It includes taking medicine as prescribed, monitoring blood pressure response to
therapy, and adopting lifestyle recommendations increasing exercise, decreasing salt intake,
and increasing fruits and vegetable consumption. Any selfcare activities that will be done by
the patient who has a hypertension should be assist and monitor by the nurse assistant to help
patient achieve goals for attaining a healthy blood pressure. According to the world health
organization (WHO), one way to better control hypertension is to involve patients in their
own self-care surveillance. Setting your goals and planning how to reach them is essential in
nearly every one of life's endeavors. When you are seeking to accomplish multiple goals at
the same time, it is necessary to prioritize and determine which goals are the most important
and why. It helps you to maintain a clear focus on reaching the most important goals first and
taking the steps to ensure that you do.

The medications used for hypertensions are angiotensin II receptor blockers, calcium
channel blockers, diuretics, beta blockers, alpha receptor blockers, direct renin inhibitors,
central a2- Agonist, reserpine, and direct arterial vasodilators. These are the drugs that are
legislated and controlled by the government, carefully checked and regulated to gain the
therapeutic effects. In this case we used two-drug combination using angiotensin-converting
inhibitors and thiazide diuretic drugs. Since these drugs are first line on the treatment for
hypertension 1 we used captopril and hydrochlorothiazide since it was associated with
prediabetes.

The outcome of the treatment is undergoingly effective since the patient understands with
the knowledge of hypertension and provided the ways on how to deal and prevent the
worsening of hypertension. Therefore we conclude that it is an effective regimen on the
approach of the
Drug Legislation And Controlled Substance

The congress of the Philippines formulated a law that defines the legal and illegal drugs
and how they are used. A controlled substance is generally a drug or chemical whose
manufacture, possession, or use is regulated by a government, such as illicitly used drugs or
prescription medications that are designated by law.

Angiotensin II receptor blockers

Calcium channel blockers

Diuretics, beta blockers

Alpha receptor blockers

Direct renin inhibitors

Central a2- Agonist

Reserpine

Direct arterial vasodilators

Generic Names

A term referring to the chemical makeup of a drug rather than to the advertised brand
name under which the drug is sold. A term referring to any drug marketed under its chemical
name without advertising. Generic drugs marketed without brand names are less expensive than
brand-name drugs even though they are chemically identical to brand-name drugs and meet U.S.
Food and Drug Administration (FDA) standards for safety, purity and effectiveness.

Generic and brand names available for ACE inhibitors

 enalapril (Vasotec)

 captopril (Capoten)

 lisinopril (Zestril and Prinivil)

  benazepril (Lotensin)

 quinapril (Accupril)

 perindopril (Aceon)

 ramipril (Altace)

 trandolapril (Mavik)

 fosinopril (Monopril)

 moexipril (Univasc)

Generic and brand names available for ARBs

 losartan (Cozaar)
 irbesartan (Avapro)
 valsartan (Diovan)
 candesartan (Atacand)
 olmesartan (Benicar)
 telmisartan (Micardis)
 eprosartan (Teveten)
 azilsartan (Edarbi)

Brand and generic names available for beta blockers

 acebutolol (Sectral)
 atenolol (Tenormin)
 betaxolol (Kerlone has been discontinued)
 bisoprolol fumarate (Zebeta)
 carteolol (Cartrol, discontinued)
 carvedilol (Coreg)
 esmolol (Brevibloc)
 labetalol (Trandate [Normodyne - discontinued])
 metoprolol (Lopressor, Toprol XL)
 nadolol (Corgard)
  nebivolol (Bystolic)
 penbutolol (Levatol has been discontinued)
 pindolol (Visken, discontinued)
 propranolol (Hemangeol, Inderal LA Inderal XL, InnoPran XL)
 timolol (Blocadren, discontinued)

Brand and generic names available for CCBs

 amlodipine (Norvasc)
 amlodipine and atorvastatin (Caduet)
 amlodipine and benazepril (Lotrel)
 amlodipine and valsartan (Exforge)
 amlodipine and telmisartan (Twynsta)\
 amlodipine and olmesartan (Azor)\
 amlodipine and olmesartan and hydrochlorothiazide (Tribenzor)
 amlodipine and aliskiren (Tekamlo has been discontinued in the US)
 amlodipine and aliskiren and hydrochlorothiazide (Amturnide had been discontinued in
the US)
 amlodipine and perindopril (Prestalia)
 clevidipine (Cleviprex)
 diltiazem (Cardizem)
 felodipine (Plendil has been discontinued in the US)
 isradipine (Dynacirc has been discontinued in the US)
 nifedipine (Procardia, Procardia XL, Adalat CC, Afeditab)
 nicardipine (Cardene, Cardene SR)
 nimodipine (Nimotop has been discontinued in the US)
 nisoldipine (Sular)
 verapamil (Calan)

Most commonly used diuretics to treat hypertension

 hydrochlorothiazide (Hydrodiuril)
 chlorthalidone
 The loop diuretics furosemide (Lasix), bumetanide (Bumex), and torsemide (Demadex)
 The combination of triamterene and hydrochlorothiazide (Dyazide)
 metolazone (Zaroxolyn)
 Generic and brand names available for alpha blockers
 terazosin (Hytrin - brand name discontinued in the US)

doxazosin (Cardura)

Examples of brand and generic names available for alpha blockers

carvedilol (Coreg), and

labetalol (Trandate). Normodyne is discontinued brand in the US.

Orphan Drugs

An orphan drug is a pharmaceutical agent developed to treat medical conditions which,

because they are so rare, would not be profitable to produce without government assistance. The
conditions are referred to as orphan diseases.

Sotatercept

trimetazidine (LIVANTRA)

Uptravi

Over the Counter Drugs

Over-the-counter medicine is also known as OTC or non-prescription medicine. All these

terms refer to medicine that you can buy without a prescription. They are safe and effective when
you follow the directions on the label and as directed by your health care professional.

V. Bulleted Learning Points

 Diagnostic and treatment decisions should be based on multiple high quality. BP
measurements .
 Stage 1 hypertension (HTN) is now defined as 130-139/80-89. In patients with stage
1 HTN, BP-lowering meds are recommended for those with ASCVD, diabetes,
chronic kidney disease, or estimated 10-year ASCVD risk of 10% or higher.
 Recommended BP goal is less than 130/80 with or without comorbidities, including
diabetes
VI. Reference
 Acute Pain – Nursing Diagnosis & Care Plan. (2019, March 23). Retrieved from

https://nurseslabs.com/acute-pain/#

 Activity Intolerance – Nursing Diagnosis & Care Plan. (2017, September 23). Retrieved

from https://nurseslabs.com/activity-intolerance/

 Hypertension Nursing Care Plans: 6 Nursing Diagnosis. (2018, December 7). Retrieved
from https://nurseslabs.com/6-hypertension-htn-nursing-care-plans/
 Case Studies: BP Evaluation and Treatment in Patients with Prediabetes or Diabetes.
(2018, April 30). Retrieved from https://www.medpagetoday.com/resource-
centers/advances-cvd/case-studies-bp-evaluation-and-treatment-patients-
prediabetes-diabetes/1960
 Felman, A. (2019, July 22). Hypertension: Causes, symptoms, and treatments. Retrieved
from https://www.medicalnewstoday.com/articles/150109.php
 https://www.medicinenet.com/hdl_vs_ldl_cholesterol_differences/article.htm#what_is_th
e_difference_between_hdl_vs_ldl_cholesterol

 Benjamin, E. M. (2004, July 1). Case Study: Treating Hypertension in Patients With
Diabetes. Retrieved from https://clinical.diabetesjournals.org/content/22/3/137
 ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group:
Major outcomes in high-risk hypertensive patients randomized to angiotensin-
converting enzyme inhibitor or calcium channel-blocker vs. diuretic: the
Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack
Trial. JAMA288 : 2981-2997,2002
 American Diabetes Association: Hypertension management in adults with diabetes
 (Position Statement). Diabetes Care 27 (Suppl. 1):S65 -S67, 2004
 Geiss LS: Mortality in NIDDM. In Diabetes in America. 2nd ed. Harris MI, Cowie CC,
Stern MP, Boyko EJ, Reiber GE, Bennett PH, Eds. Washington, D.C., U.S.
Department of Health and Human Services, National Institutes of
Health, 1995 (NIH publ. no. 95-1468), p.233 -258
 U.K. Prospective Diabetes Study Group: Efficacy of atenolol and captopril in reducing
risk of macrovascular and microvascular complications in type 2 diabetes
(UKPDS 39). BMJ 317:713 -720, 1998
 Wingard DL: Heart disease and diabetes. In Diabetes in America. 2nd ed. Harris MI,
Cowie CC, Stern MP, Boyko EJ, Reiber GE, Bennett PH, Eds. Washington, D.C.,
U.S. Department of Health and Human Services, National Institutes of
Health, 1995 (NIH publ. no. 95-1468), p.429 -448
 Tuomelehto J, Rastenyte D, Birkenhager WH, Thijs L, Antikainen R, Bulpitt CJ, Fletcher
AE, Forette F, Goldhaber A, Palatini P, Sarti C, Fagard R: Effects of calcium
blockade in older patients with diabetes and systolic hypertension. N Engl J
Med 340:677 -684, 1999
 Huang ES, Meigs JB, Singer DE: The effect of interventions to prevent CV disease in
patients with type 2 diabetes mellitus. Am J Med111: 633-642,2001
 Case Studies (July 2015). (n.d.). Retrieved from www. pharmacytimes. com /publications
/issue /2015/july2015/case-studies-july-2015
 VII. Illustrations

Under the 2017 ACC/AHA guideline, He has stage 1 hypertension. This guideline uses a
uniform BP definition for Hypertension without regard to patient age or comorbid illnesses,
such as diabetes or chronic kidney disease.

BP Category SBP DBP

Normal < 120 And < 80

Elevated 120-129 And < 80

Stage 1 HTN 130-139 Or 80-89

Stage 2 HTN ≥ 140 Or ≥ 90

The normal guidelines of the total cholesterol level. Low- Density lipoprotein add the High-
Density lipoprotein.

Total Cholesterol Level Category

Less than 200 mg/dL Desirable
200-239 mg/dL Borderline High
240 mg/dL and above High

LDL Cholesterol Level Category

Less than 100mg/dL Optimal
100-129 mg/dL Near Optimal
130-159 mg/dL Borderline High
160-189 mg/dL High
190 mg/dL and above Very High
 HDL Cholesterol Level Category
Less than 40 mg/dL A Major Risk Factor for Heart Disease
40-59 mg/dL The Higher the Better
60 mg/dL and higher Considered Protective Against Heart Disease