J, a 42-year-old male recently diagnosed with mild hypertension, comes to your pharmacy clinic for initiation of antihypertensive therapy. He had four blood pressure readings in the clinic over the last 6 months; all of which were greater than 140/90: 150/100, 150/90, 148/100, and 142/96, all R arm sitting. He also has a strong family history of hypertension on his father’s side of the family. Today’s reading by the medical aide is 150/90 with a pulse of 92. He had home blood pressure readings twice a day for the last 2 weeks, taken by his wife who is a registered nurse. They range from 120- 138/82-88. He had a complete physical examination by his primary care provider 2 weeks ago along with appropriate laboratory tests. All findings and results were normal or unremarkable. What should be your next steps?
LK is a 68-year-old female with hypertension previously seen in the pharmacy clinic by a colleague (now on maternity leave) for the last 2 years. Chart review reveals that LK is under good control (120s over 70s) and has been steadily losing weight at the rate of 5 lb per year. She is on chlorthalidone 25 mg q AM, lisinopril 20 mg q AM, and carvedilol 6.25 mg bid. Her home blood pressure readings are excellent over the last 6 months with a slight downward trend in evening and bedtime readings (as low as 100/66). In taking her history, she denies any problems except for occasional dizziness that occurs most frequently after getting up from the dinner table, especially after a big meal (about one to two times/week). The other change is that she has begun to walk 2 miles a day with her new nextdoor neighbor, with whom she is becoming fast friends. Her sitting blood pressure reading by you today at 11 AM is 110/68 with a pulse of 72. What should you do next?
