05-25-2008, 08:15 PM
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.
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.