Pharmacologic treatment of hypertension

Abstract

A 47-year-old African-American man presents to your outpatient clinic after learning that his blood pressure (BP) was 180/95 mmHg at a public health screening. He has been feeling well overall and does not take any medications regularly. He is anxious about his future risk of kidney disease, as his father recently has been initiated on hemodialysis for end stage kidney disease related to hypertension. Your patient is currently employed as a police officer and notes that on many work days he eats several fast food meals. His physical examination is pertinent for a seated BP of 176/89 mmHg, a pulse of 86 beats per minute, and a laterally displaced PMI on cardiac examination. Funduscopic exam reveals focal narrowing of retinal arterioles. He has no peripheral edema. The rest of the physical examination is unremarkable. He is wondering what medication he can take to help control his BP and is worried about side effects that might interfere with his work performance.