Question

A 65 year old African American male comes to the clinic today for a blood pressure check. He has been taking vasotec (Enalapril), 40 mg, daily for the past 3 months but his blood pressure remains elevated despite patient remaining compliant. The nurse practitioner decides to:

a. Increase his vasotec (Enalapril) dose to 40 mg, twice per day
b. Add Valsartan (Diovan), 40 mg, daily
c. Add amlodipine (Norvasc), 10 mg, daily
d. Educate patient on sodium restriction and other lifestyle changes.

Answer 1

The nurse practitioner would not increase Vasotec (Enalapril) beyond the recommended dosage, but could consider adding amlodipine a calcium channel blocker, for better blood pressure control. Additionally reinforcing education on sodium restriction and lifestyle changes is essential.

Step-by-step explanation:

A 65-year-old African American male comes to the clinic for a blood pressure check. He has been taking Vasotec (Enalapril), 40 mg, daily for the past 3 months, but his blood pressure remains elevated despite patient compliance. Considering the medications available for treating hypertension and the recommended approaches for escalation the nurse practitioner decides to:

• Not increase the Vasotec (Enalapril) dose to 80 mg per day because the maximum recommended dose is usually 40 mg.
• Potentially add amlodipine (Norvasc), 10 mg, daily, a calcium channel blocker, as this can be used effectively in combination with an ACE inhibitor like Enalapril.
• Education on sodium restriction and lifestyle changes could be reinforced as an adjuvant to pharmacologic therapy considering that these measures are often foundational to blood pressure control.

Since the question appears to come from an educational perspective and is considering hypothetical treatment modifications, it is crucial that these decisions be based on clinical guidelines, patients' unique medical history and current health status.