05-24-2010, 09:46 AM
A 64-year-old man presents to your office for his yearly physical. This is his first visit to your office, and he admits that he has not been to a physician in over a decade. He takes no medications and denies tobacco or alcohol use. He is a recently retired accountant and started "health walks" three times a week, for 45 minutes at a time. He has been keeping salt out of his diet, going to yoga classes, and trying to lose weight for the last six months. At a local mall, his blood pressure was read as 160/80 mm Hg at a free screening booth.
On physical examination, his weight is 80 kg (176 lbs), and he stands 58" tall. Blood pressure taken in the office is 154/88 mm Hg, heart rate is 74/min, and temperature is normal. The physical exam shows AV nicking on funduscopic evaluation. The EKG has normal sinus rhythm at 74/min with no ST changes. The following lab results are available:
Sodium 143 mEq/L, potassium 5.0 mEq/L, bicarbonate 24 mEq/L, BUN 10 mg/dL, creatinine 1.1 mg/dL, glucose 96 mg/dL; cholesterol (total) 210 mg/dL, HDL 50 mg/dL, triglycerides 180 mg/dL, LDL 124 mg/dL, VLDL 36 mg/dL. Urinalysis is normal.
What is the next appropriate step regarding the management of this patient?
(A) ACE inhibitor
(B) Atenolol and simvastatin
© Advise further lifestyle modification and recheck blood pressure in 4 to 6 weeks
(D) Hydrochlorothiazide
(E) Repeat the blood pressure
On physical examination, his weight is 80 kg (176 lbs), and he stands 58" tall. Blood pressure taken in the office is 154/88 mm Hg, heart rate is 74/min, and temperature is normal. The physical exam shows AV nicking on funduscopic evaluation. The EKG has normal sinus rhythm at 74/min with no ST changes. The following lab results are available:
Sodium 143 mEq/L, potassium 5.0 mEq/L, bicarbonate 24 mEq/L, BUN 10 mg/dL, creatinine 1.1 mg/dL, glucose 96 mg/dL; cholesterol (total) 210 mg/dL, HDL 50 mg/dL, triglycerides 180 mg/dL, LDL 124 mg/dL, VLDL 36 mg/dL. Urinalysis is normal.
What is the next appropriate step regarding the management of this patient?
(A) ACE inhibitor
(B) Atenolol and simvastatin
© Advise further lifestyle modification and recheck blood pressure in 4 to 6 weeks
(D) Hydrochlorothiazide
(E) Repeat the blood pressure