This document provides guidance on screening, diagnosing, and managing hypertension through patient-centered care and therapeutic lifestyle changes. It presents a case study of a 45-year-old man with new onset high blood pressure and discusses further evaluation, initial recommendations, and follow-up based on guideline-recommended treatment goals. The document also addresses how care may differ based on patient characteristics and explores assessing psychosocial factors that could impact treatment.

1. Hypertension--Patient-Based Learning
John Brill, MD & Alan Wolkenstein, MSW
August 2004
• Learn to screen for, diagnose and treat hypertension
• Learn to tailor hypertension management to each patient’s needs, particularly
recommendations for therapeutic lifestyle changes.
• Learn to be a family physician: use time as your ally, develop a long-term relationship
with patients, cope with uncertainty, find out and use your patient’s life story to help
improve their health.
A 45- year old man presents as a new patient. He recently had his blood pressure
checked during a pre-employment physical. He was told that it was high and that he
needed to see a physician. He doesn’t recall that it was ever high before.
His past medical history is basically unremarkable. He takes no regular meds but
uses Tums most days, has no allergies. He works at as a welder at a local factory, first
shift. He is a high school graduate and did some tech courses in the navy. He is
married with 3 children aged 15-20. He smokes 1 pack/day with a total smoking
history of 38 pack-years. He drinks beer on weekends and sometimes after work.
Enjoys hunting and fishing, watching football and basketball. He plays basketball in
the driveway with his two teenaged sons pretty often, but doesn’t get any other
exercise. On exam, height is 72”, weight 110 kg. His blood pressure in the office is
160/100. Exam is otherwise unremarkable.
What further history do you need to obtain? What are you thinking about his blood
pressure? What will you recommend? What measures might increase the likelihood of your
recommendations being followed and sustained?
He returns in one month, having attempted to comply with your recommendations.
Blood pressure is 156/95. What will you recommend? What measures might
increase the likelihood of your recommendations being followed and sustained?
A friend has told him he should have an EKG and a stress test. What is the data?

2. He returns in one month, having attempted to comply with your recommendations.
He returns in one month. Blood pressure is 138/86. What will you recommend?
What will you tell him about: taking aspirin; drinking coffee?
How would your evaluation & treatment have differed if the patient was:
20 years old?
African-American?
Wanted to try something ‘natural’?
An airline pilot?
Reported that his blood pressure was normal when he checked it at home and in stores
How will you assess and use the following information?
Patient’s relationships with others
Stressors
Coping skills

3. Health beliefs about high blood pressure
Signs/symptoms of anxiety/depression
Effect of the high blood pressure on his life
Sexual functioning
Resources:
Chobanian AV, Bakris GL, Black HR, Cushman WC. The Seventh Report of the Joint
National Committee on Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure: The JNC 7 Report. JAMA 2003; 289:2560.
Norman M Kaplan, MD, Burton D Rose, MD Therapy in essential hypertension:
Recommendations From UpToDate, 2004
Available online through Aurora library website
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
(ALLHAT). JAMA 2002; 288:2981.