Cardiovascular Disease in Women

Case Study Vignette

J.S. is a 54-year-old Hispanic woman who presents to her primary-care clinician for follow-up regarding elevated blood pressure. She was last seen 2 weeks prior with a blood pressure of 162/94 mmHg. She has no significant medical history, she is a 1 ppd tobacco user with a history of 25 pack-years, and she has a family history of premature cardiac death.

Evaluation:

Her vital signs are as follows: height, 5 ft 4 in.; weight, 188 lb.; pulse, 84 beats/min; blood pressure, 168/98 mmHg; and body mass index, 32.3. As J.S. has been found to be hypertensive (>149/90) on two consecutive office visits, starting an antihypertensive medication is indicated.

Questions:

What is your initial choice for an antihypertensive medication in this patient? (Support your treatment plan with a discussion of the evidence based guideline you utilized)

Which therapeutic lifestyle change is a priority in helping J.S. achieve blood pressure control?

Which of the following diagnostic tests would you order for J.S. to establish a baseline before starting an anti-hypertensive?