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Old 09-04-2012
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Default Manage the BP in this Patient

A 45 year old man has TWO PREVIOUS READINGS of BP within 140-145 mm Hg and diastolic pressure within 86-90 mm Hg. At this time his BP is 142/88, His Height is 180 cm and weight is 75 kg. His family history is negative for cardiac disease, stroke, diabetes or hyperlipidemia. The Patient has not had any significant illness. He exercises regularly , does not smokes and takes no medication. He has three or four alcoholic drinks daily on weekdays and up to six drinks on weekends. Which of the following is most appropriate next best step in management ?

A. Treat with B Blocker

B. Treat with Diuretic

C. Treat with ACE inhibitor

D. restriction of alcohol consupmtion

E. Weight reduction only.
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D. restriction of alcohol consupmtion
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Old 09-05-2012
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B. Diuretics is first line Rx
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Answer D. restriction of alcohol consupmtion

Most important is weight loss ,but this patients weight is not a risk factor .Alcohol is a major risk factor for this patient
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D Restriction of Alcohol consumption.. this guy is the true definition of an alcoholic

No problem with his weight he is in a normal BMI so there is no contribution there

Recommend D and continue with lifestyle modifications.
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Yes the answer is D.

But I am confused isnt his BP >140 so shudnt we start wid drigs too.
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Quote:
Originally Posted by usmle2011 View Post
Yes the answer is D.

But I am confused isnt his BP >140 so shudnt we start wid drigs too.
The cut off value to start drug therapy is 130/90 mmHg on three separate occasions in the absence of risk factors and once lifestyle modifications have been tried and failed. You are in no hurry to start him on anti-HT since he will be stuck with them for the rest of his life.
Moreover, his diastolic is only 88 mmHg at this time and 86 mmHg & 90 mmHg on previous occasions. (That's the reason--and a clue--not to start him on anti-HT)
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[QUOTE=Novobiocin;145106]The cut off value to start drug therapy is 130/90 mmHg on three separate occasions in the absence of risk factors QUOTE]

Hopefully this is a typo, please double check your info especially since people may use these comments and lose points.

JNC 7 and U.S. Dept of Health and Dr. Fischer agree with the following:

Cut off is 140/90 in the absence of compelling indication (HF, Post-MI, CAD high risk, DM, CKD, recurrent stroke prvntn)

Cuf off is 130/80 in the absence of compelling indication if DM or CKD is present.
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Old 09-06-2012
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Quote:
Originally Posted by WhoDoUlisten2 View Post
Quote:
Originally Posted by Novobiocin View Post
The cut off value to start drug therapy is 130/90 mmHg on three separate occasions in the absence of risk factors
Hopefully this is a typo, please double check your info especially since people may use these comments and lose points.

JNC 7 and U.S. Dept of Health and Dr. Fischer agree with the following:

Cut off is 140/90 in the absence of compelling indication (HF, Post-MI, CAD high risk, DM, CKD, recurrent stroke prvntn)

Cuf off is 130/80 in the absence of compelling indication if DM or CKD is present.
Thank you for pointing out my mistake.
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