Harvey HoyaProblem ListH.H. is a 57 y.o. overweight Hispanic construction worker who presents for evaluation of an elevated blood pressure reading at a recent local health fair. He reports “some” shortness of breath with moderate exertion, intermittent headaches, and interrupted sleep with snoring. Physical examination is notable BP 172/94 L and 178/98 R after 5 minutes of rest; laterally displaced PMI; and funduscopic findings of A-V nicking. Was told he had elevated BP in the past but took no action. FH is positive for hypertension

and cardiovascular disease. H.H. denies smoking or alcohol use but admits to a diet high in sodium and low in fruits and vegetables. His waist circumference is 42 inches, and he has a body mass index (BMI) of 31. Laboratory findings reveal an elevated fasting glucose level of 110 mg/dL and a total cholesterol level of 220 mg/dL.

The primary concern for H.H. is his elevated blood pressure. Hypertension, also known as high blood pressure, is a major risk factor for cardiovascular disease and is associated with increased morbidity and mortality (Whelton et al., 2018). The American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines define hypertension as a systolic blood pressure (SBP) of 130 mm Hg or higher or a diastolic blood pressure (DBP) of 80 mm Hg or higher in adults (Whelton et al., 2018). Based on H.H.’s blood pressure readings, he meets the criteria for diagnosis.

H.H. also reports symptoms such as shortness of breath, headaches, and interrupted sleep with snoring. These symptoms may be suggestive of obstructive sleep apnea (OSA), a common sleep disorder that is often associated with hypertension (Whelton et al., 2018). OSA is characterized by repetitive episodes of complete or partial upper airway obstruction during sleep, leading to disrupted breathing and oxygen desaturation. This can result in daytime sleepiness, fatigue, and increased risk of cardiovascular events (American Academy of Sleep Medicine, 2014). The presence of snoring suggests a likelihood of OSA in H.H.

Additionally, H.H. has a history of elevated blood pressure that he did not take action on. This is concerning as untreated hypertension can have serious health consequences. Chronic hypertension can lead to damage in the blood vessels, heart, kidneys, and other organs over time (Whelton et al., 2018). The presence of symptoms such as shortness of breath and funduscopic findings of A-V nicking further indicate the need for intervention and management of H.H.’s hypertension.

H.H. also has several lifestyle factors that contribute to his elevated blood pressure. He is overweight and has a high waist circumference, both of which are associated with an increased risk of hypertension (Whelton et al., 2018). His diet, which is high in sodium and low in fruits and vegetables, also contributes to his blood pressure elevation. Poor dietary choices, especially high sodium intake, can lead to fluid retention and increased vascular resistance, thereby increasing blood pressure (Whelton et al., 2018). Additionally, H.H. has an elevated fasting glucose level, which may indicate the presence of insulin resistance or prediabetes, further compounding his cardiovascular risk.

It is essential to consider H.H.’s family history, as he has a positive family history of hypertension and cardiovascular disease. Family history plays a significant role in the development of hypertension and can contribute to the genetic predisposition for the condition (Whelton et al., 2018). Understanding his family history will help guide the management of his hypertension and cardiovascular risk.

Based on the information provided, the primary diagnosis for H.H. is hypertension. The secondary diagnoses include obstructive sleep apnea, elevated fasting glucose, and dyslipidemia (elevated total cholesterol). The key issues to address in H.H.’s case are the management of his hypertension, lifestyle modifications, and the need for further evaluation and treatment of his other conditions, including OSA and dyslipidemia. The treatment plan will focus on lifestyle modifications, such as weight loss, dietary changes, and increased physical activity, as well as pharmacological interventions to control his blood pressure and manage his other conditions. Multidisciplinary care involving primary care providers, cardiologists, sleep specialists, and dieticians will be crucial in providing comprehensive management for H.H. and reducing his cardiovascular risk.