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Old 08-19-2012
tyagee's Avatar
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Default HTN treatment q..please give reason along

A 22-year-old man comes for a routine evaluation. He feels well but has gained 6.8 kg (15 lb) during the past 4 years. He has a sedentary job as a software engineer, has a 3-pack-year history of cigarette smoking, and consumes two beers on most nights.
His parents both have hypertension, and his mother has type 2 diabetes mellitus.
On physical examination, blood pressure is 140/95 mm Hg,
pulse rate is 90/min, and respiration rate is 12/min; BMI is 29.
There is no evidence of edema.
Laboratory studies, including a plasma fasting glucose level, fasting lipid panel, serum electrolyte level, serum creatinine level, and urinalysis results, are normal.

Which of the following is the most appropriate next
management step?
(A) Atenolol
(B) Diltiazem
(C) Hydrochlorothiazide
(D) Lifestyle modifications
(E) Lisinopril
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Old 08-19-2012
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D

cigarette smoking cessation is the most imp factor to reduse the CV and stroke risks.
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Do what you Love, Love what you do...!
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Old 08-19-2012
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Quote:
Originally Posted by tyagee View Post
A 22-year-old man comes for a routine evaluation. He feels well but has gained 6.8 kg (15 lb) during the past 4 years. He has a sedentary job as a software engineer, has a 3-pack-year history of cigarette smoking, and consumes two beers on most nights.
His parents both have hypertension, and his mother has type 2 diabetes mellitus.
On physical examination, blood pressure is 140/95 mm Hg,
pulse rate is 90/min, and respiration rate is 12/min; BMI is 29.
There is no evidence of edema.
Laboratory studies, including a plasma fasting glucose level, fasting lipid panel, serum electrolyte level, serum creatinine level, and urinalysis results, are normal.

Which of the following is the most appropriate next
management step?
d)Lifestyle modifications

smoking is the risk factor for HTN (nicotine leads vasoconstriction)
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Old 08-19-2012
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(D) Lifestyle modifications

Can't start him on anti-HT based on one BP reading without associated symptoms.

He has so many risk factors:
1. Smoking
2. Obesity
3. Family h/o HT & DM
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Old 08-20-2012
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Lifestyle modifications

In ayoung patient with so many risk factors (male, smokes, family history, sedentary,obesity). One has to first adress and eliminate those risk factors, the most dangerous one being smoking and then obesity.

It is incredible, just by eliminating obesity and smoking you can lower BP to normal leve,s without any other intervention.
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Old 08-20-2012
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Remember, wt reduction is the first best step.
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Old 08-20-2012
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Default D

D
Single BP reading is not a diagnosis of HTN. So, all option for medical therapy are not indicated.
Beside the pt is over weight(BMI 29), so first step would be life style modification & most importantly starting with wt loss.
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