Step I HTN treatment question

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bigfrank

bigfrank

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A 53-year-old man with a negative PMH has 2 B/P readings in the 160/90 range. 1st drug in treatment should be:
a. Clonidine
b. Metoprolol
c. Furosemide
d. Hydralazine
e. Nifedipine
 
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bigfrank said:
A 53-year-old man with a negative PMH has 2 B/P readings in the 160/90 range. 1st drug in treatment should be:
a. Clonidine
b. Metoprolol
c. Furosemide
d. Hydralazine
e. Nifedipine
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f. No drug. You need to take a third bp measurement at a different time before considering any kind of action (unless the sbp is over 210 or the dbp is over 120)


Sorry, I'm in pimp-mode where the correct answer is never among the choices given. 😀
 
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Aside from getting 3 independent readings with a +HTN result....the 1st line is always diet modification and exercise. If the HTN is refractory to those changes, I would go Diuretic/B Blocker...depending on the race, DM status, and other factors..
 
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I don't want to feel left out, so I will answer with yet another answer that was not given as a choice. Assess for end-organ damage (urinalysis, fundoscopy, EKG, etc...) and if positive, do not wait for another reading, nor diet and exercise and give metoprolol or HCTZ. 😉
 
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Sorry for the inherent confusion. This exact question was on my medicine shelf yesterday. It was a bad question, I felt. No ethnicity given.
 
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kas23 said:
You put metoprolol, right?
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YES, I did. If it had been HCTZ rather than Furosemide, I would have obviously put it. But Furosemide? I had never seen that as a 1st-line tx for HTN. But I could be wrong. I know that some trials have shown BBs to reduce mortality/morbidity, so I went with that over the others (besides the diuretic).
 
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frank, I think you're right on top of it.
Of those choices metoprolol is clearly the most appropriate (HCTZ would be better 1st line but wasn't a choice) for someone with an unremarkable PMH.

Also remember, the shelf exams can be a tad behind the times given that much of their content comes from retired step 2 questions.
 
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And remember, the Shelf questions, as well as Step 2 say "pick the best answer," not pick the correct answer. A small, but significant difference. 😉
 
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