Group 2
CC/PMH:
BJ is a 45 yobm who comes in today as a follow-up for blood pressure. He was seen in
your
office 2 weeks ago for an upper respiratory infection during which time his blood
pressure
measured 190/94. He also stopped in 3 days ago and had it checked by one of your
nurses. It
was 186/96. Today it measures 192/94. He takes no medication and has been over his
respiratory infection for at least a week. He is allergic to penicillin (rash) and sulfa
(breathing
difficulties).
Group 2 Case Questions:
1. When BJ initially had his blood pressure taken, he had an upper respiratory infection
(URI). What medications might a person take related to an URI that can increase blood
pressure?
Several medications used to treat an upper respiratory infection can raise blood
pressure. Pseudoephedrine (Sudafed) is found in decongestants, Phenylephrine is
found in many cold and flu products, and finally combination drugs such as DayQuil and
Mucinex D. Decongestants such as Sudafed and Phenylephrine act as sympathetic
agents, activating alpha-1 adrenergic receptors on systemic blood vessels, which
causes blood vessels to constrict, resulting in increased blood pressure. Combination
meds often contain decongestants, thereby increasing blood pressure via the same
vasoconstrictive mechanism. All these medication classes taken for upper respiratory
infections have been found to potentially increase blood pressure (Rosenthal &
Burchum, 2026).
2. What would you prescribe as therapy for hypertension?
, BJ has clear evidence that his hypertension is not only related to this upper
respiratory infection, as evidenced by his hypertension before starting medications for
upper respiratory infection, and post-respiratory infection resolved while still presenting
with hypertension. BJ's hypertension needs pharmacologic treatment. Considering this
patient has no listed comorbidities or labs, in the absence of a compelling indication, a
thiazide diuretic is currently recommended as first-line treatment for most patients. Also,
BJ is African American, and it has been found through controlled trials that African
American adults have shown that diuretics can decrease morbidity and mortality in
African American adults. Therefore, diuretic drugs are drugs of first choice (Rosenthal &
Burchum, 2026). While BJ has a documented sulfa allergy with breathing difficulties,
current clinical evidence indicates that cross-reactivity between antimicrobial
sulfonamides and nonantimicrobial sulfonamides (like thiazides) is absent because
thiazides lack the arylamine and heterocyclic structures responsible for the allergic
response (Cline et al., 2025). BJ needs strict education and instructions to call the office
immediately if any respiratory distress arises while on a new thiazide diuretic.
BJ will be started on Hydrochlorothiazide 12.5 mg once daily. With BJ's high
readings placing him technically in stage 2 hypertension, monotherapy might not be
sufficient, but with no prior hypertension treatment, it is a safe starting approach. At
follow-up in one month, if blood pressure is not optimal, a second blood pressure
medication will be added. Lab work and clinical presentation will determine second-line
treatment if needed.
3. What are your goals of therapy?
CC/PMH:
BJ is a 45 yobm who comes in today as a follow-up for blood pressure. He was seen in
your
office 2 weeks ago for an upper respiratory infection during which time his blood
pressure
measured 190/94. He also stopped in 3 days ago and had it checked by one of your
nurses. It
was 186/96. Today it measures 192/94. He takes no medication and has been over his
respiratory infection for at least a week. He is allergic to penicillin (rash) and sulfa
(breathing
difficulties).
Group 2 Case Questions:
1. When BJ initially had his blood pressure taken, he had an upper respiratory infection
(URI). What medications might a person take related to an URI that can increase blood
pressure?
Several medications used to treat an upper respiratory infection can raise blood
pressure. Pseudoephedrine (Sudafed) is found in decongestants, Phenylephrine is
found in many cold and flu products, and finally combination drugs such as DayQuil and
Mucinex D. Decongestants such as Sudafed and Phenylephrine act as sympathetic
agents, activating alpha-1 adrenergic receptors on systemic blood vessels, which
causes blood vessels to constrict, resulting in increased blood pressure. Combination
meds often contain decongestants, thereby increasing blood pressure via the same
vasoconstrictive mechanism. All these medication classes taken for upper respiratory
infections have been found to potentially increase blood pressure (Rosenthal &
Burchum, 2026).
2. What would you prescribe as therapy for hypertension?
, BJ has clear evidence that his hypertension is not only related to this upper
respiratory infection, as evidenced by his hypertension before starting medications for
upper respiratory infection, and post-respiratory infection resolved while still presenting
with hypertension. BJ's hypertension needs pharmacologic treatment. Considering this
patient has no listed comorbidities or labs, in the absence of a compelling indication, a
thiazide diuretic is currently recommended as first-line treatment for most patients. Also,
BJ is African American, and it has been found through controlled trials that African
American adults have shown that diuretics can decrease morbidity and mortality in
African American adults. Therefore, diuretic drugs are drugs of first choice (Rosenthal &
Burchum, 2026). While BJ has a documented sulfa allergy with breathing difficulties,
current clinical evidence indicates that cross-reactivity between antimicrobial
sulfonamides and nonantimicrobial sulfonamides (like thiazides) is absent because
thiazides lack the arylamine and heterocyclic structures responsible for the allergic
response (Cline et al., 2025). BJ needs strict education and instructions to call the office
immediately if any respiratory distress arises while on a new thiazide diuretic.
BJ will be started on Hydrochlorothiazide 12.5 mg once daily. With BJ's high
readings placing him technically in stage 2 hypertension, monotherapy might not be
sufficient, but with no prior hypertension treatment, it is a safe starting approach. At
follow-up in one month, if blood pressure is not optimal, a second blood pressure
medication will be added. Lab work and clinical presentation will determine second-line
treatment if needed.
3. What are your goals of therapy?
