A 71-year-old man with well-controlled type 2 diabetes and no cardiovascular disease has a total cholesterol well below 200 mg/dL and an LDL <100 mg/dL, but his HDL ranges from 20-29 mg/dL. His systolic BP has been elevated (140-160 mm Hg) since age 18, but it drops to the 120s or 130s when taken a…
How soon after starting a patient on an antihypertensive medication should its effects be reviewed and the dosage adjusted?—Bhavana Japi, MD, New Hyde Park, N.Y. The timing of dosage adjustment depends on three factors: the class of medication, the severity of the hypertension, and the ability of the patient to follow home BP and titrate…
An integrated approach to hypertension and depression treatment yielded significantly better results for both conditions in a recent six-week pilot study. Patients in the integrated-care arm showed fewer…
Most patients have no symptoms of hypertension until they suffer a major event. Here is a guide to help diagnose and manage this “silent killer.”
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…
Women with high but normal albumin/creatinine ratios (ACRs) are much more likely to develop hypertension than women with lower ACRs…
How would you manage a 31-year-old gravida 3 para 3 who is hypertensive (BP 130-160/90-110 mm Hg)? The woman is breastfeeding a 2-month-old infant and wants to continue until the baby’s first birthday because he has demonstrated intolerance to multiple formulas. The mother’s history includes a sulfa allergy and moderate persistent asthma that is currently…
Two readers ask about rising creatinine levels following ACE inhibitor therapy: At what serum creatinine level should discontinuation of an ACE inhibitor or angiotensin receptor blocker be implemented? Is the recommendation different for a patient with diabetes vs. a patient without?—Regina A. Roman, DO, Murrells Inlet, S.C. How long does it take for the creatinine…
According to new recommendations, patients once considered to be “prehypertensive” now require more than just lifestyle modification.
Are you responsible for a patient’s noncompliance? A plaintiff’s lawyer will try to convince a jury you are.
