A 53 year old African American man is in for follow up of his elevated blood pressure

A 53 year old African American man is in for follow up of his elevated blood pressure. He was seen last week in your office for a Department of Transportation commercial driver’s examination where his blood pressure was 176/92. Subjective questioning is negative. BP today is 174/94.

His physical exam is remarkable for a loud S2, sustained PMI at 5icslmcl, an S4 gallop is present. The remainder of his physical exam is unremarkable.

Family history is remarkable for high blood pressure.

Self describes his lifestyle as pretty sedentary due to driving long hours every day. Diet is often fast food with many cups of coffee.

• EKG – NSR with LVH by voltage
• CBC – normal
• CBP – normal except for glucose 154 (fasting). Fingerstick last week was 152
• A1C – 7.8

1.List 5 subjective questions it would be very important to know about this patient.

2.Explain the significance of the loud S2 finding.

3.What does the finding of his PMI indicate?

4.Explain the significance of the PMI in the normal location.

5.Explain the significance of the S4 finding.

6.Explain the finding of LVH given his current circumstances.

7.What additional diagnostics or testing (if any) you would like to order?

8.What are the top two diagnoses you are going to address at this time?

9.What is your pharmacologic plan for this man? Why did you choose the agent you did? Be sure to state your rationale and references.

10.Identify 5 lifestyle modifications to improve his health that he could implement in his current situation.