Hypertension management

[jwars6]

had a question about management that i saw on my test today. basically, a guy comes in for routine physical in his 40s, has hypertension in 150s/90s but otherwise completely healthy, has a family history of diabetes and coronary artery disease, but has no past medical history himself. what antihypertensive would you start? a thiazide? an ACE? I know first line is a thiazide for primary hypertension without risk factor, but with his family history i didn't know if that warranted an ACE. It did explicitly state his bg was wnl.

Thanks!

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[link2swim06]

Wait and recheck?

+1

Not hypertension until you have two measurements on separate dates.

 

[Raryn]

The answer is either recheck or (if that's not an option), start with a thiazide. JNC7 are the last official US guidelines, and while there's really no reason not to start with an ACEI in modern practice, they're the guidelines for the purposes of the test until we get new ones.

 

[Instatewaiter]

had a question about management that i saw on my test today. basically, a guy comes in for routine physical in his 40s, has hypertension in 150s/90s but otherwise completely healthy, has a family history of diabetes and coronary artery disease, but has no past medical history himself. what antihypertensive would you start? a thiazide? an ACE? I know first line is a thiazide for primary hypertension without risk factor, but with his family history i didn't know if that warranted an ACE. It did explicitly state his bg was wnl.

Thanks!

Lifestyle modification + recheck.

JNC late should come out sometime soon, as people have been saying as long as I have been a student. It will supplant beta blockers and thiazides in favor of ACEi/ARB and CCBs.

 

[link2swim06]

This is random, I had a roommate in college with the nickname link2swim05.

Did you go to school in ohio?

 

[link2swim06]

Yep, he's a pharmacist now.

Yep that is the guy I was thinking of...he was one of my best friends in elementary school....small world.