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Question 1#

A 53-year-old woman presents to the emergency room with a minor injury and is found to have a blood pressure of 150/102, possibly elevated as a result of pain. On follow-up at your office, her BP on two occasions is 142/94 despite good dietary habits and reasonable exercise. Her history and physical are otherwise normal. Urinalysis and serum creatinine and potassium are normal. Based on recent recommendations of the JNC 7 (The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure),

which of the following is accurate information to give her? 

a. At age older than 50, high diastolic BP becomes a more important cardiovascular risk factor than high systolic BP
b. She has prehypertension and does not need drug therapy at this time
c. Thiazide diuretics would be a good initial choice for her
d. Initiating therapy with two anti-hypertensives would be preferred based on her current BP
e. Estrogen-replacement therapy would be helpful in delaying her need for anti-hypertensives

Correct Answer is C

Comment:

A key point in the JNC 7 is that a thiazide diuretic should be used in most patients with uncomplicated hypertension when diet and lifestyle modifications are not sufficient. Other major points include (1) systolic BP greater than 140 is a more important cardiovascular risk factor than diastolic BP in persons older than 50; (2) individuals normotensive at age 55 still have a 90% lifetime risk of developing hypertension; (3) CVD risk doubles, beginning at 115/75, for each rise in BP of 20/10; (4) a new category of prehypertension has been designated with systolic BP 120 to 139 or diastolic BP 80 to 89, with emphasis on healthy diet and lifestyle modifications; (5) if BP greater than 20/10 above goal is present at the outset, consider initiating therapy with two agents. Estrogen-replacement therapy does not lower blood pressure.