,Week 7 i-Human Case Study: Uncontrolled Stage 2
Hypertension with Metabolic Comorbidities in a 57-Year-Old
Male
Course: NRNP 6512 – Advanced Health Assessment and Clinical Reasoning
Week: 7
Date of Encounter: April 12, 2026
Patient Age/Sex: 57-year-old male
Ethnicity: Caucasian
Setting: Outpatient primary care clinic
Chief Complaint: “My blood pressure is staying high even though I take my medicine every
day.”
I. SUBJECTIVE DATA (Comprehensive History)
Chief Complaint (CC) in Patient’s Own Words
“I’ve had high blood pressure for maybe eight years, and it’s always been fine on the little
white pill. But for the last few months, every time I check it at the grocery store machine or at
home with my wife’s cuff, it’s up around 168 over 98. I don’t feel bad, but my wife got worried
and made me come in.”
History of Present Illness (HPI) – Detailed Chronology
The patient is a 57-year-old male with a known 8-year history of essential hypertension,
previously well controlled on lisinopril 10 mg once daily. Approximately four months ago
(December 2025 – January 2026), he began noticing higher readings on sporadic home BP
checks using his wife’s automatic upper-arm monitor. Over the past eight weeks, he has
kept a written log (brought to today’s visit) showing:
• Morning BP (7–8 AM, before medication): Range 152–172 systolic, 92–104 diastolic.
Average 162/96 over 14 readings.
• Evening BP (7–8 PM): Range 148–166 systolic, 88–98 diastolic. Average 158/92.
, He denies missing any doses of lisinopril. He refilled his prescription 3 weeks ago and takes it
every morning with breakfast. No recent change in pill appearance or manufacturer. He denies
using any over-the-counter supplements (e.g., licorice, ma huang, ephedra). However, he
reports taking ibuprofen 400 mg for left knee pain 3–4 times per week for the past 6
months, which he did not previously mention to his provider.
Temporal relationship: He started a new job as a warehouse supervisor 6 months ago
(October 2025). The job requires long hours (45–50/week), standing/walking on concrete
floors, and managing a team of 20 workers. He describes it as “more stressful than my old
desk job.” His weight has increased by 12 pounds over the past 12 months (from 186 lb to
198 lb). He has not changed his diet or exercise habits. He eats fast food 3–4 times per week
(burgers, fries, soda) and estimates his sodium intake as “high – I salt everything.”
Last office visit: 6 months ago (October 2025). BP was 134/84, and lisinopril was continued.
No labs were drawn at that time.
Review of systems – positive findings only:
• Mild fatigue, worse in afternoons (occurs ~4 days/week).
• Occasional morning headache (once every 10–14 days, frontal, dull, resolves by noon).
• Snoring (by wife report) – loud, irregular, wife says he sometimes “stops breathing for a
few seconds.”
• No chest pain, palpitations, dyspnea, orthopnea, PND, edema, hematuria, or focal
neurologic deficits.
Past Medical History (PMH)
Condition Year Diagnosed Treatment/Status
Essential hypertension 2018 Lisinopril 10 mg daily
Hyperlipidemia 2020 Atorvastatin 20 mg daily
Osteoarthritis, left knee 2021 Ibuprofen PRN, no surgery
Gastroesophageal reflux (mild) 2019 Occasional antacids
Past Surgical History (PSH)
• None
Hypertension with Metabolic Comorbidities in a 57-Year-Old
Male
Course: NRNP 6512 – Advanced Health Assessment and Clinical Reasoning
Week: 7
Date of Encounter: April 12, 2026
Patient Age/Sex: 57-year-old male
Ethnicity: Caucasian
Setting: Outpatient primary care clinic
Chief Complaint: “My blood pressure is staying high even though I take my medicine every
day.”
I. SUBJECTIVE DATA (Comprehensive History)
Chief Complaint (CC) in Patient’s Own Words
“I’ve had high blood pressure for maybe eight years, and it’s always been fine on the little
white pill. But for the last few months, every time I check it at the grocery store machine or at
home with my wife’s cuff, it’s up around 168 over 98. I don’t feel bad, but my wife got worried
and made me come in.”
History of Present Illness (HPI) – Detailed Chronology
The patient is a 57-year-old male with a known 8-year history of essential hypertension,
previously well controlled on lisinopril 10 mg once daily. Approximately four months ago
(December 2025 – January 2026), he began noticing higher readings on sporadic home BP
checks using his wife’s automatic upper-arm monitor. Over the past eight weeks, he has
kept a written log (brought to today’s visit) showing:
• Morning BP (7–8 AM, before medication): Range 152–172 systolic, 92–104 diastolic.
Average 162/96 over 14 readings.
• Evening BP (7–8 PM): Range 148–166 systolic, 88–98 diastolic. Average 158/92.
, He denies missing any doses of lisinopril. He refilled his prescription 3 weeks ago and takes it
every morning with breakfast. No recent change in pill appearance or manufacturer. He denies
using any over-the-counter supplements (e.g., licorice, ma huang, ephedra). However, he
reports taking ibuprofen 400 mg for left knee pain 3–4 times per week for the past 6
months, which he did not previously mention to his provider.
Temporal relationship: He started a new job as a warehouse supervisor 6 months ago
(October 2025). The job requires long hours (45–50/week), standing/walking on concrete
floors, and managing a team of 20 workers. He describes it as “more stressful than my old
desk job.” His weight has increased by 12 pounds over the past 12 months (from 186 lb to
198 lb). He has not changed his diet or exercise habits. He eats fast food 3–4 times per week
(burgers, fries, soda) and estimates his sodium intake as “high – I salt everything.”
Last office visit: 6 months ago (October 2025). BP was 134/84, and lisinopril was continued.
No labs were drawn at that time.
Review of systems – positive findings only:
• Mild fatigue, worse in afternoons (occurs ~4 days/week).
• Occasional morning headache (once every 10–14 days, frontal, dull, resolves by noon).
• Snoring (by wife report) – loud, irregular, wife says he sometimes “stops breathing for a
few seconds.”
• No chest pain, palpitations, dyspnea, orthopnea, PND, edema, hematuria, or focal
neurologic deficits.
Past Medical History (PMH)
Condition Year Diagnosed Treatment/Status
Essential hypertension 2018 Lisinopril 10 mg daily
Hyperlipidemia 2020 Atorvastatin 20 mg daily
Osteoarthritis, left knee 2021 Ibuprofen PRN, no surgery
Gastroesophageal reflux (mild) 2019 Occasional antacids
Past Surgical History (PSH)
• None
