First line antihypertensive

For this patient, the first-line antihypertensive drug would be an Angiotensin-converting enzyme inhibitor such as enalapril or an Angiotensin receptor blocker such as candesartan. In general, a renin-angiotensin-aldosterone-system blocker plus a beta blocker, such as betaxolol or metoprolol, should be explored initially. Beta blockers and thiazide diuretics have been linked to undesired side effects such as haemodynamic and metabolic problems in both of these diseases. Most thiazide diuretics and -blockers have been linked to decreased insulin sensitivity as well as increased LDL cholesterol and triglyceride levels (Mark et al, 1999). Obesity, insulin resistance, and hyperinsulinemia all have a close relationship. However considering the age of the patient and the cardiovascular risk, a cardio selective beta blocker should be considered first.

In regard to the second question of the research, I would consider adding a diuretic, most preferably, a thiazide diuretic as opposed to increasing her beta blocker medication. Beta blockers will reduce MT’s cardiac output and renin activity which are obviously high in this obese patient. Addition of a beta blocker will not be of any additional benefit to the patient but only add to the metabolic abnormalities. Low dose thiazide diuretics such as chlorothiazide should be added to improve blood pressure control (Landsberg et al, 2013).

Multi-drug regimes in the management of such comorbidity are faced with a challenge of non-compliance. Varying rates of compliance have been reported especially on older patients with chronic illnesses such as hypertension. Documented data in the United States show that about 50% of older adults do not adhere to one or more of their chronic medications. The pharmacist or physician should educate the patient on the importance of medication compliance.

References

Mark, A. L., Correia, M., Morgan, D. A., Shaffer, R. A., & Haynes, W. G. (1999). Obesity-induced hypertension. Hypertension, 33(1), 537-541.

Landsberg, L., Aronne, L. J., Beilin, L. J., Burke, V., Igel, L. I., Lloyd‐Jones, D., & Sowers, J. (2013). Obesity‐related hypertension: Pathogenesis, cardiovascular risk, and treatment—A position paper of the The Obesity Society and the American Society of Hypertension. Obesity, 21(1), 8-24.