Case 1 Background: Elderly with high blood pressure and Asthma

Irene is a 65 year old woman living with her husband in a house in a small suburb.

Irene suffers from Asthma and Hyptertension (high bloodpressure). Irene must take medication for her Asthma, as well as for her Hypertension.

Also, her doctor has instructed her to measure her blood pressure at a regular interval.

Irene often forgets taking her hypertension medicine, while she most often remembers her asthma spray. Irene seldomly remembers measuring her blood pressure, and when she does, it is most often late in the evening, while watching television, and often she forgets to sit down and rest for for a while, before measuring her blood pressure, often resulting in a higher blood pressure then nessecary.

Irene visits her doctor quite infrequently (3-5 times a year), and seldom remembers bringing her notebook with the values (which contains only very few entries).

Irene knows that Hypertension is dangerous, with an increased risk of hearth attacks and strokes amongst other risk factors, but does not think about it in general.

Some facts on Asthma and Hypertension:

"Asthma is a common chronic lung disease. It has been defined by the National Heart, Lung and Blood Institute as a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness (bronchospasm), and an underlying inflammation. The interaction of these features of asthma determines the clinical manifestations and severity of asthma and the response to treatment.

Public attention in the developed world has recently focused on asthma because of its rapidly increasing prevalence, affecting up to one in four urban children" (cited from Wikipedia)

"Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the blood pressure is chronically elevated. In current usage, the word "hypertension"[1] without a qualifier normally refers to systemic, arterial hypertension.[2]
Hypertension can be classified either essential (primary) or secondary. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. About 95% of hypertension is essential hypertension.Secondary hypertension indicates that the high blood pressure is a result of (i.e., secondary to) another condition, such as kidney disease or tumours (pheochromocytoma and paraganglioma).
Persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysm, and is a leading cause of chronic renal failure. Even moderate elevation of arterial blood pressure leads to shortened life expectancy. At severely high pressures, defined as mean arterial pressures 50% or more above average, a person can expect to live no more than a few years unless appropriately treated.[3] Beginning at a systolic pressure of 115 mm Hg and diastolic pressure of 75 mm Hg (commonly written as 115/75 mm Hg), cardiovascular disease (CVD) risk doubles for each increment of 20/10 mm Hg.[4] In the United States, prehypertension is defined as blood pressure from 121/81 mm Hg to 139/89 mm Hg and although not a disease category, it is a designation chosen to identify individuals at high risk of developing hypertension.[4] The Mayo Clinic specifies that blood pressure is normal if it is 120/80 mm Hg or below.[5]
In individuals older than 50 years, hypertension is considered to be present when a person's blood pressure is consistently at least 140 mm Hg systolic or 90 mm Hg diastolic. Patients with blood pressures over - 130/80 mm Hg along with Type 1 or Type 2 diabetes, or kidney disease require further treatment.[4]" (cited from Wikipedia)