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Old 11-07-2012
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Arrow Gyrus Daily Questions; Internal Medicine #77

A 63-year-old female presents to your office for a routine check-up. She has no present complaints. Her past medical history includes DM, type 2, and hypertension. Her current medications include glyburide and atenolol. She does not smoke. She drinks 2-3 glasses of wine 1-2 times a week. Three consecutive BP measurements were in the range of 138-142/87-90 mmHg. Physical examination is within normal limits. Her recent fasting glucose level was 250 mg/dL. ECG recorded 1 month ago showed left ventricular hypertrophy. Which statement about the BP control in this patient is the most accurate?

A. BP is within acceptable range
B BP is within optimal range
C. It is better to keep systolic pressure less than 130 mmHg to slow end-organ damage
D. Diastolic BP is within acceptable range. but systolic is not
E. Systolic BP is within acceptable range, but diastolic is not
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Old 11-07-2012
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C. It is better to keep systolic pressure less than 130 mmHg to slow end-organ damage

Ideally below 130/80
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Quote:
C. It is better to keep systolic pressure less than 130 mmHg to slow end-organ damage
Yup it seems to be the most reasonable Ans
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Old 11-08-2012
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Anse is correct C. It is better to keep systolic pressure < 130 mmHg to slow end-organ damage

Traditionally a goal, blood pressure is considered to be below 140/90 mmHg. But it is recently recognized that BP needs more tight control in diabetics and patients with chronic renal failure. These two groups of patients are especially sensitive to high BP, that's why the values of systolic BP for these patients should be kept lower than 130 mmHg and diastolic BP lower than 80 mmHg to prevent end organ damage.
Blood pressure could be considered in acceptable range (Choice A) if the patient was not diabetic. According to JNC-7 report (JNC stands for Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) BP is considered optimal when it is below 120/80 mmHg (Choice B). In this patient both systolic (Choice E) and diastolic (Choice D) BP are above the goal values.

Gyrus Daily Questions; Internal Medicine #77-blood-pressure-guidelines.png
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