MEDizzy - You are seeing a 45-year-old female patient of your partner

Feed Library Learning Discuss Leaderboard Journal

Cardiology

You are seeing a 45-year-old female patient of your partner for the first time in your clinic. A quick review of the patient’s medical record shows that her systolic blood pressure was greater than 140 mm Hg at both of her last clinic appointments. Her medical history is otherwise significant only for diabetes mellitus. Her blood pressure today is 164/92. What is the best next step in her blood pressure management?

ExplanationHypertension is defined as elevated blood pressure on two or more separate readings. In a patient with stage 1 HTN and no other cardiac risk factors, consideration may be given to a therapeutic trial of diet and lifestyle modification. This patient, however, has diabetes mellitus. Both the American Diabetes Association and JNC-7 recommend a target blood pressure of 130/80 or lower in patients with diabetes. It is unlikely that the patient will be able to reach target blood pressure with diet and lifestyle modification alone, although these interventions will be important adjunct therapies. The JNC-7 recommends a thiazide diuretic as initial therapy for most patients with hypertension. Patients with diabetes and hypertension, however, benefit more from an ACE inhibitor, especially if they have signs of renal damage (elevated creatinine or proteinuria). There is no contraindication to the use of calcium-channel blockers, but their increased expense without increased benefit would prevent answer d from being correct. Evidence of end-organ damage, such as left ventricular hypertrophy on an echocardiogram, is unlikely to change your initial management.