Leon is an African American, 55-year-old male. He is a non-smoker, is a nondrink

Question

Leon is an African American, 55-year-old male. He is a non-smoker, is a nondrinker, and has a healthy weight for his height. On weekends, he coaches a youth baseball team in his community and loves to eat hot dogs and nachos with the children after they play. Leon attends a community health clinic to have a routine urinalysis and blood pressure monitored. Leon attends a community health clinic to have a routine urinalysis and blood pressure monitored. At his last visit, his blood pressure was 168/92 mm Hg. Although Leon was pleased that “the lower number dropped from 96 to 92,” his physician was still concerned. He warned Leon about the dietary choices he was making and reminded him to limit his salt intake. He also renewed Leon’s prescription for diuretics and added an ACE inhibitor to Leon’s treatment regimen

1.Speculate how Leon’s ethnicity contributes to his hypertension. What other determinants of health contribute to the prevalence of hypertensive disease in this population?

2.What is the significance of an elevated systolic pressure, even in the absence of diastolic hypertension?

3.What is the mechanism of action of the two classes of drugs Leon was prescribed for the management of his hypertension?

Explanation / Answer

Ans. 1.

Leon is an African-American. The ethnicity has a major contribution to his Hypertension. The prevalence of hypertension is higher among African-Americans than white. According to Literature, an author Jones DW, in 2002 shows that African-Americans experiences a higher burden of Hypertension with increase in prevalence from 35-41 % compared to 24-28% in Whites. The hypertension in African-Americans is more severe and has an earlier age of onset. That's the reason Leon's Physician was more concerned.

Other determinants contributing to Prevalence of Hypertension in African-American -

(a) Obesity; (b) Smoking; (c) Excessive Sodium intake; (d) Alcohol intake

Ans. 2.

If the diastolic pressure is normal or lower and the systolic blood pressure is higher, then it is a common form of Hypertension, known as Isolated Systolic Hypertension.

Let's first see the role of Systolic and diastolic pressure. The systolic pressure is the force that blood exerts on the artery walls, when heart contracts pumping out the blood. The diastolic pressure is the force when the heart relaxes allowing the blood to flow into the heart.

The Isolated Systolic Hypertension occurs when systolic pressure is above 140 mmHg with a normal or lower diastolic pressure. This might be important risk factor for Stroke and other Heart diseases. It can further cause damage to vital organs such as Kidney, Brain, Heart and Eyes. Therefore this kind of hypertension needs to be concerned and treated. This Hypertension is a reflection of the loss of function of arterial wall leading to Endothelial dysfunction and Arteriosclerosis.

Ans. 3.

In Isolated Systolic Hypertension, Diuretics and ACE inhibitors are generally prescribed.

Mechanism of Action of Diuretics - Diuresis is a process of increase in urine output and the drugs responsible for this are known as Diuretics. The Diuretics produces Diuresis by inhibition of Sodium reabsorption at differents parts of Renal tubular system such as Proximal Convoluted tubule and Distal Convoluted tubule etc. The different types of diuretics are Thiazide diuretics, Loop diurectics, Potasium sparing diuretics and Carbonic anhydrase inhibitors.

Mechanism of Action of ACE inhibitors - These inhibitors are meant to inhibit an enzyme known as Angiotensin Converting enzyme (ACE) which converts Angiotensin I to Angiotensin II. The Angiotensin II binds to Angiotensin II receptors, in turn responsible for narrowing of blood vessels and increase in blood pressure. Thus ACE inhibitors inhibits the formation of Angiotensin II and reduces Hypertension.

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