Patient Profile - Mr. Landon is a 45-year-old African American man. At a screening clinic two months ago, his BP was found to be 150/95 mm Hg. His primary care provider has followed him for the past month. During this time, he has been taking hydrochlorothiazide (a diuretic), 12.5 mg/day. He is here today for a follow-up visit.

Subjective Data:

Father died of stroke at age 60
Patient is a widower who lives alone
Mother is alive but has hypertension and a history of myocardial infarctionStates he feels fine and is not a 'hyper' person
Smokes one pack of cigarettes daily (for the past 28 yrs)
Drinks 1-2 six-packs of beer on most Friday and Saturday nights
Has heard that BP drugs 'make you impotent'
Objective Data Physical Examination:

Mild retinopathy (retinal arteriolar narrowing on ophthalmoscopic examination)
BP: 166/108 mm Hg (average of two readings, 1 min apart)
Apical impulse palpable in the fourth intercostal space just lateral to themidclavicular line
Diagnostic Studies:

ECG: mild left ventricular hypertrophy
Urinalysis: protein 30 mg/dL (0.3 g/L)
Serum creatinine level: 1.6 mg/dL (141 mmol/L)
Collaborative Care:

Low-sodium, Dietary Approaches to Stop Hypertension (DASH) diet
Hydrochlorothiazide 25 mg twice per day, oral (PO) (dosage increase 25 mg/day)
Nicardipine, a calcium channel blocker, sustained release 30 mg PO bid