Hypertension

Titrating antihypertensive meds

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…

Trial integrates depression and BP treatment

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…

Race-specific hypertension treatment

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…

Managing hypertension in a breastfeeding mother-to-be

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…

Creatinine increase after ACE inhibitor

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…

What next for this patient’s high BP?

After one year on telmisartan (Micardis) 80 mg, my 56-year-old patient’s BP is still 180/90 mm Hg. An earlier trial of hydrochlorothiazide (HCTZ) resulted in weight loss, and a previously prescribed beta blocker was stopped because of tiredness and cold extremities. The patient developed joint and back pain on amlodipine. His labs are within normal…

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