HTN q easy one - nfa

[ArchivalUser]

A 28-year-old male with type 1 diabetes mellitus is seen in the clinic for routine follow-up. The patient has hypertension. He is being maintained on an insulin pump and lisinopril 5 mg daily. He has been on this dose of antihypertensive medication for approximately 6 weeks. He has a creatinine of 1.0 mg/dL and no proteinuria. Blood pressure is 138/88. What do you recommend?

A. Continue the current dose of lisinopril and return for follow-up in 3 months as the patient has achieved his target blood pressure of less than 140/90.
B. Ask the patient to follow up for a return visit in 6 weeks; if his blood pressure remains at this level, increase the dose of lisinopril.
C. Increase lisinopril to 10 mg daily to achieve a goal blood pressure of less than 130/80.
D. Assure the patient that he is suffering from "white-coat" hypertension and plan no intervention.
E. Switch the patient from lisinopril to losartan.

[ArchivalUser]

it's CCCCC
we do not swich before try to increase the dose;;

[ArchivalUser]

B?

[ArchivalUser]

oh sorry I didn't see the B
I have to go the bed
good night Guys

[ArchivalUser]

it's " B"

[ArchivalUser]

The answer is C.

Angiotensin converting-enzyme inhibitors are considered first-line agents for the treatment of hypertension in diabetic patients. These agents have been shown to decrease the progression of diabetic nephropathy and albuminuria. The goal blood pressure in diabetic patients and patients with chronic kidney disease is lower than that for patients with essential hypertension alone. The blood pressure target should be less than 130/90 in these individuals. This patient should have his dose of lisinopril increased at the current visit as the effects of the lisinopril should be seen within 6 weeks. There is no indication to switch the patient from an ACE inhibitor to an angiotensin receptor blocker unless the patient develops intolerance to the ACE inhibitor, with the most frequent adverse effect being cough. The issue of "white-coat" hypertension is frequently revisited in the medical literature. If this is an ongoing concern of the treating physician, ambulatory blood pressure monitoring may be warranted. However, in this young individual with diabetes mellitus the problems associated with untreated hypertension warrant further attention.