This case study discusses a 64-year-old male patient with uncontrolled hypertension and several comorbidities, including diabetes and COPD. Despite being on triple antihypertensive therapy, his blood pressure remains above target, prompting a reassessment of his medication plan, which includes discontinuing certain drugs and adding lisinopril. Education on dietary management and physical activity is also emphasized to help manage his conditions.

1. A CASE STUDY ON UNCONTROLLED
HYPERTENSION
PRESENTED BY
Arunima Shrestha
Harif Ghimire
Mamata Panthi
Romit Subba
Trilochan Pandey
[B.Pharmacy 2nd Year]

2. SOAPE NOTE
 Subjective – JF is a 64 y/o A.A. M seen today for f/u for his
HTN.
 PMH- HTN*14 yrs, DM II, Stage 2 COPD, BPH & recent
recovery from cold
 SH- Lives alone, occasional drinker, no smoking
 FH- Father & mother had HTN
 MH- Hydrochlorothiazide 25mg po q am
Doxazosin 2mg po q am
Carvedilol 12.5mg po bid
Mucinex D 2 tablets q12 for cough
Naproxen 220mg po q8h for pain
Metformin 500mg po bid

3. SOAPE NOTE
 Objective- Past[3 months ago] B.P 160/85 mm Hg
B.P 162/90 mm Hg HR- 76 bpm
Wt-95 kg Ht.-6’2 BMI-26.8(overweight)
Na- 138mEq/l Ca- 9.7mEq/l K- 4.7mEq/l
Total Chol.- 171mg/dl LDL- 99mg/dl
HDL- 40mg/dl TG- 158mg/dl
S.cr- 2.2 mg/dl Glucose- 110mg/dl
U.A- 6.7 mg/dl

4. SOAPE NOTE
 Assessment
- -JF’s BP is not at goal ,because he is diabetic his
goal should be <130/80mmHG.
- -Despite of triple antiHTN therapy ,B.P is not
optimal because of many factors including use of
Mucinex D(contains pseudoephedrine),
Naproxen(NSAID) & non compliance with low
sodium diet
- -ACEIs or ARB as drug of choice in pt. with
Diabetes. CCB is also an option(as he is AA)
- -Continue HCTZ

5. -Use of non selective beta blocker is not best selection for
COPD pt.
-JF has BPH & is on Doxazosin , an alpha blocker that
seems to control his BPH symptoms as well. However,
dizziness & headaches like side effects of Doxazosin
can be minimize by take the dose at night
-Continue metformin

6. SOAPE NOTE
 Plan
-Discontinue guaifenesin/pseudoephedrine
preparation(especially if no longer needed for cold
symptoms) or give product containing only
guaifenesin next time.
-Discontinue Naproxen . Go for an
alternative(eg.acetaminophen) for headache and
gout
-Discontinue Carvedilol gradually
-Add Lisinopril 5mg po once daily, increase if not
enough.
It can cause dry cough or angioedema.
Monitor B.P, K, renal function, glucose , Lipid profile

7. -Continue HCLTZ 25mg po qam
-Continue Doxazosin 2mg po qhs
Change dosing schedule to qhs to reduce possible
Doxazosin-induced dizziness
-Continue metformin 500mg po bid

8. SOAPE NOTE
 Education
-Emphasize the importance of low-Na diet. Assist JF in recognizing
healthy diet options and consider referring him to a dietitian.
-Encourage physical activity compatible with his COPD. Consider
gradual and steady aerobic exercise 3-4x/week. May refer to
pulmonary rehab program if JF faced difficulty
-If the patient develops persistent dry cough after using lisinopril, it can
be replaced with ARB (e.g. losartan).
-Thiazide diuretics can make pt. sensitive to sunlight. Pt must be sure
to apply a sunscreen before any extended exposure to sunlight.
Thiazide diuretics may also cause to lose potassium. Potassium
should be balance carefully. If pt. experience cramping in feet or
lower extremities, this may be a sign that potassium has dropped. If
this occurs, notify physician.

9. THANK YOU

10. QUESTIONS??????