An obese 48-year-old African American woman was sent from the emergency department for follow-up of newly diagnosed asymptomatic hypertension (BP 226/130 mm Hg). She was started on lisinopril/hydrochlorothiazide (Zestoretic) 40/25 mg daily and clonidine 0.2 mg b.i.d. The patient has Wolff-Parkinson-White syndrome and cannot take calcium channel blockers or beta blockers. One month following her first visit, her BP was 168/102 and her pulse 106. She is tired from the clonidine and does not want to increase the dosage. Is there something else can I give her?
—JULIE PARVE, MSN, Fox Point, Wis.

I would suggest isosorbide dinitrate/hydralazine (BiDil). BiDil is the only FDA-approved heart failure medication specifically for African Americans. This medication was approved in June 2005 after the African American Heart Failure Trial found clinically based evidence of a lower mortality rate in African Americans and not any other race.

Adding BiDil to the existing Zestoretic regimen and encouraging weight loss should lead to improvement in this patient. Check the information on how to wean patients off clonidine and start a new medication to prevent adverse effects.
—Debra Kleinschmidt, PhD, PA (118-10)