Hypertension Case Studies1-3

Case Study 11
Mr AP, a 58-year-old man has arranged a “heart check” appointment at the community pharmacy.
His blood pressure is found to be 160/95 mmHg. His patient medication record shows that he has
recently received prescriptions for metformin 500mg three times a day, atorvastatin 40mg daily,
aspirin 75mg daily, etoricoxib 90mg daily, and sulfasalazine e/c 1g twice a day. He has a history of
type two diabetes mellitus and rheumatoid arthritis.

1. What drug(s) may have affected his blood pressure?

2. What action should be taken?

3. What additional action should be taken?

Case Study 21
Mrs PP, a 55-year-old woman of Black African-Caribbean origin, is found to have consistently elevated
blood pressure over several weeks; her lowest reading was 155/98 mmHg. She is overweight and has
diabetes and is being treated with metformin. Her renal function and urinalysis are both normal.

1. What action would you take?

2. What lifestyle advice would you provide?

3. What antihypertensive drug treatment would you offer and in what order?

Case Study 31
Mrs GJ, a 73-year-old woman has a long-standing history of hypertension and intolerance to
antihypertensive drugs. Bendroflumethiazide was associated with acute attacks of gout, she
developed breathlessness and wheezing whilst taking bisoprolol, amlodipine caused flushing and
headache and doxazosin was associated with intolerable postural hypotension. Four weeks earlier, she
had been started on enalapril, but then complained of a dry persistent cough. Her biochemistry
results has remained normal.

1. What drug(s) could be the likely cause of her cough?

2. What other antihypertensive drug treatment could be offered?

References
1. Williams, H. (2018). Chapter 19: Hypertension. In Clinical Pharmacy and Therapeutics (ed. Whittlesea, C and Hodson, K). 6th ed.
Churchill Livingstone: London. pp.317-334.
2. National Institute for Health and Care Excellence (NICE). (2019, updated 2022). Hypertension in adults: diagnosis and management.
[Online] NG136. Available from: www.nice.org.uk/guidance/ng136 (accessed 18 September 2023).
3. British National Formulary (BNF). 86. (September 2023-March 2024). The Pharmaceutical Press: London.