A 75-year-old man has hypertension for 15 years and has had no hypertension-associated end-organ damage. His medications are maximum doses of amlodipine and lisinopril, which he tolerates well. On examination, BP 142/68mmHg, HR 72/min and RR 12/min. There are no significant findings on cardiopulmonary examination. He has normal electrolytes and kidney function. Which of the following is the most appropriate next step in managing this patient's blood pressure?
سؤال مجاني 6 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: A. Add hydrochlorothiazide
At 75 years, 142/68 mmHg is above target in the cohort's sources (ACC/AHA <130/80 including older adults; the cohort summary table uses <140/90 for age <80). He is already on maximum ACEi + CCB, so the next step is to add a thiazide as the third agent (A + C + D). The old bank answer "no change" rests on JNC8 (<150/90 for age 60+), which these sources do not use.
ليش كل خيار صح أو غلط
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A
ليش صح
He is already on maximum doses of two agents (ACEI and CCB) with BP above goal, so a third agent is considered; a thiazide is among the listed add-on classes.
✓ Step Up To Medicine 6th (Hypertension).pdf · p. 9 -
B
ليش غلط
β-Blockers are not commonly used as initial therapy without a specific indication because of adverse cardiovascular outcomes, especially in elderly patients.
✓ Step Up To Medicine 6th (Hypertension).pdf · p. 8 -
C
ليش غلط
ACCOMPLISH found ACEI plus amlodipine more effective than ACEI plus a diuretic, so dropping amlodipine for a thiazide gives up the better pair; the third drug is added instead.
✓ Step Up To Medicine 6th (Hypertension).pdf · p. 9 -
D
ليش غلط
The ACC/AHA goal is below 130/80 for most patients, including older patients, so a systolic of 142 on maximum two-drug therapy is still above goal.
✓ Step Up To Medicine 6th (Hypertension).pdf · p. 8
- المصدر
- Step Up To Medicine 6th (Hypertension).pdf · p. 8
Step Up To Medicine 6th (Hypertension).pdf · p. 9
CARDIOLOGY-HTN.pdf · p. 6 - المحاضرة
- Hypertension · Cardiology · Module B
- ظهر في
- Cardio bank