“Chronic Disease Management in a 33-Year-Old Male With Hypertension and Gout.”

Abstract

     Hypertension and gout are common chronic conditions in adults. Management can be  difficult when social, financial, and behavioral factors interfere with long term care. We present the case of a 33-year-old male with hypertension and recurrent gout flare ups  who lacked continuous care due to limited insurance coverage. His lifestyle included high intake of dairy, consumption of snacks and pastries, cigar use, and very little physical activity . These factors combined with inconsistent medication adherence and lack of primary care contributed to continuous flare ups of the gout. After getting a new job and health insurance, he seeked out new medical care for medication renewal and health screening. This case highlights the importance of addressing diet, exercise, and harm-reduction counseling which are important in the management of chronic diseases. This report shows how primary care engagement can improve disease control and health promotion in patients who relied on the use of urgent care or the emergency room. 

Introduction

     Gout is caused when our bodies enter a state of high uric acid and is influenced strongly by diet, alcohol intake, and underlying conditions. Gout can affect quality of life through recurrent flares and chronic pain. Hypertension also is sensitive to lifestyle factors such as sodium intake, physical activity, weight, and stress.

     This case demonstrates the challenges encountered by a 33-year-old male with hypertension and gout who did not receive care by a primary care provider and relied on urgent care for medication refills. This case is important because it shows how primary care engagement can make a difference in a patient’s health. Also important to note that the patient was put on hydrochlorothiazide which can induce hyperuricemia and may worsen his gout if he was adherent to the medication. It is important to detect these abnormalities and provide your patient with the best hypertension medication that won’t interfere with his gout. With primary care these findings can be acknowledged along with dietary counseling, exercise planning, and harm-reduction strategies tailored for the patient.

 

Case Presentation- 33-year-old male who presents to new established primary care after obtaining new employer-sponsored health insurance. He has had limited engagement with the healthcare system since adolescence. 

History of Present Illness: 33 y/o M with a history of hypertension and recurrent gout. Previously treated for conditions through urgent care visits. His most recent gout flare occurred six months ago on his RT first toe after consuming lobster, red wine, and cheese. Treatment with corticosteroids from urgent care resolved symptoms. He notes occasional shortness of breath when carrying heavy groceries or his son’s tricycle up stairs, although he tolerates climbing three flights without difficulty when gout is not active. Admits to not taking his current medications consistently.

Medications: Hydrochlorothiazide 25 mg daily, Diltiazem 120 mg daily, Allopurinol 100 mg daily. No known drug allergies reported.

Social History: Occupation: UPS processing center. Alcohol: socially only on special occasions. Smoking: approximately four cigars per week. 

Family History: Unavailable; patient is adopted.

Physical Examination: Vital signs: BP 140/88, HR 72, RR 18, Temp 98.6°F, Height 5′10″, weight 200lbs, waist circumference 43 in

 

Screening Needs: Given gaps in care, he is due for: Hypertension screening, routine labs (CBC, CMP, fasting lipid panel, A1c, uric acid level), STI screening based on shared decision-making

Immunizations: influenza, COVID-19 vaccine, Hep B, Tdap,  HPV, possibly but based on shared decision making, currently catch-up recommended up to age 27, and shared decision making for 27-45 (CDC,2025).

 

Diet Assessment & Dietary Plan: Patient currently drinks full-fat dairy (up to 1 gallon/day), High consumption of meat, pastries, snack foods, and sugary drinks, which should all be limited. Recommended to reduce full-fat milk intake to ≤2 servings/day; transition to low-fat milk. Limit red meat and shellfish to reduce gout flare risk. Try to add fruits for snacks and vegetables, whole grains, and lean proteins. Encourage hydration with water instead of excess milk. 

Exercise Assessment & Exercise Plan: The patient is physically active at work but does not engage in structured exercise. He expresses a desire for a healthier lifestyle but struggles with follow-through. Exercise Recommendations: Start with low-impact exercise, such as 20–30 minutes of brisk walking 3–4 times per week. Incorporate activities he enjoys, such as basketball, 1–2 times per week as tolerated.

 

Harm Reduction / Brief Intervention Plan

•  Smoking: Discuss cigar smoking increases cardiovascular risk; recommend reducing from 4/week to ≤1/week, with an eventual goal of cessation. Offer counseling and discuss drug therapies to gauge patients’ interest.

• Alcohol: Although intake is minimal,  counsel in avoiding alcohol during gout-sensitive periods. 
• Medication adherence: Address cost concerns and reinforce the importance of daily adherence for blood pressure and uric acid control. If possible once-daily medications to simplify the regimen.

Discussion
Primary care visits are essential to maintaining your health and assessing your health status as you age. This case demonstrates the challenges individuals face when they lack consistent medical guidance. Without a primary care provider overseeing treatment, patients may not understand how their medications interact with their conditions or how lifestyle factors influence disease progression.

     In this case, the patient had been prescribed hydrochlorothiazide for hypertension. Thiazide diuretics are known to increase uric acid levels and provoke gout. According to UpToDate, patients with gout who remain adherent to thiazide therapy may experience worsening hyperuricemia if not managed with appropriate urate-lowering strategies(Stamp,2025). This highlights the importance of continuous care where medication regimens must be evaluated in the context of a patient’s full medical history. Oftentimes, an urgent care or emergency department won’t have the time or information needed to do this work properly.

 

Conclusion: This case shows how consistent healthcare access, education, and medication review are essential for effective chronic disease management. With guidance, patients can achieve better control of hypertension and gout and reduce future health risks.

 

References:

Centers for Disease Control and Prevention. (2025). Adult immunization schedule, United States, 2025 [PDF]. https://www.cdc.gov/vaccines/hcp/imz-schedules/downloads/adult/adult-combined-schedule.pdf CDC+1

Stamp, L. K. (2025). Diuretic-induced hyperuricemia and gout. In R. F. Connor (Ed.), UpToDate. Retrieved December 3, 2025, from https://www.uptodate.com/contents/diuretic-induced-hyperuricemia-and-gout