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A 49-year-old female presents to you for an initial visit to establish health care. She has no past medical history and denies a family history of diabetes mellitus, early cardiovascular disease, or renal disease. Her blood pressure on presentation is 185/112. She denies headache or visual complaints. She has no chest pain, shortness of breath, or change in urine color. Her physical examination is normal with the exception of an S4 gallop heard at the fourth intercostal space just to the left of the sternum. An electrocardiogram is significant for left ventricular hypertrophy and left axis deviation. There are no signs of cardiac ischemia. Urinalysis shows no red blood cells or proteinuria. What is your recommendation for therapy for this patient?
A. Initiate therapy with hydrochlorothiazide in combination with a beta blocker.
B. Initiate therapy with hydrochlorothiazide alone.
C. Initiate therapy with an ACE inhibitor alone.
D. Advise the patient to go to the nearest emergency department for further treatment for a hypertensive emergency.
E. Advise the patient on lifestyle modifications and plan a return visit for 2 weeks.
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A. Initiate therapy with hydrochlorothiazide in combination with a beta blocker
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aaaaaaaaaaaaa,,,,,,,,,,,,thiazide for systolic and beta for diastolic
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but u first try a single agent and then if not controled then go for a combo therapy right??
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sd have read in kaplan that always start two drug regime when u have 180/110mg.
irrespective this above kaplan issue, look at patient, he has diastloic dysfunction and LVH. so plz give him BB. he is unable to pump th boold again huge systemic pressure, against hight afteload. give time to left ventricle to pump by slowing it BB.
many things which tells us to use BB and thiazide in above.
again see awys start thiazide in any hypertensive as first line of therpay if he has not a well known comorbid.
this is the concept which i believe. it could be the wrong. me too stil learning.
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tx vanco....tx for the expl....i keep getting confused but wha u r saying is absolutely correct.
tx again
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dear (sd) you are most welcome.
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The answer is A.
The most recent recommendation for the treatment of hypertension is for the initiation of combination therapy as first-line treatment if blood pressure is higher than 160/100 mmHg. A thiazide diuretic should be a part of all combination regimens and can be combined with an ACE inhibitor, calcium channel blocker, angiotensin receptor blocker, or beta blocker. The patient has no symptoms of hypertensive emergency and has no evidence of end organ damage on physical and laboratory examination. Thus, the patient does not need intravenous administration of antihypertensive medications and can safely be managed as an outpatient on oral medications with close follow-up. Lifestyle modifications have at best been shown to lower systolic pressure by 10 to 20 mmHg and would not alone be sufficient for treatment of this degree of hypertension.
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