Problem
Case
K.H. is a 67-year-old African-American man with primary hypertension and diabetes mellitus. He is currently taking an angiotensin-converting enzyme (ACE) inhibitor and following a salt-restricted weight loss diet. He is about 30 pounds over his ideal weight. At his clinic visit his blood pressure is noted to be 135/96. His heart rate is 70 beats/min. He has no complaints. His wife brought a blood pressure cuff and stethoscope with her in the hope of learning to take her husband's blood pressure at home.
Task
i. What risk factors for primary hypertension are evident from K.H.'s history and physical data?
ii. What is the rationale for treating K.H. with an ACE inhibitor? What is the mechanism of action? What part of the blood pressure formula do they affect?
iii. K.H.'s hypertension is not adequately controlled. What other intervention might be considered?