I have a tendency to hunt down rare and fun and bizarre diseases, but we shouldn't neglect common solid family medicine diagnoses as well.Challenges: According to JNC-7 guidelines,
1. What would you use to treat the otherwise-healthy African American gentleman with the BP reading above?
2. If instead, the same patient has chronic kidney disease and a BP reading of 165/102, what would you use?
3. You recommend dietary sodium restriction (100mEq/L). What kind of BP response can you tell the patient to expect? Choices: No effect on SBP, 5mmHg reduction, 10mmHg reduction, 15mmHg reduction, 20mmHg reduction.
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JNC-7
1. 158/99 is the upper limit of Stage 1 HTN; thiazide diuretics are recommended here (especially for African Americans).
2. Stage II hypertension requiers a 2-drug combination; a thiazide and an ACEi would be best here given the chronic kidney disease.
3. The approximate systolic BP reduction is 2-8mmHg with dietary sodium restriction.
Sources: JNC-7 Guidelines, Wikipedia.
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