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Hypertension in an African American Man with Diabetes


A 54-year-old African American man with a history of type 2 DM, hypertension, and gout presents for diabetes follow-up. What’s the best therapy for his hypertension?

DL is a 54-year-old African American man who presents to the clinic for diabetes mellitus (DM) follow-up. His past medical history includes type 2 DM, hypertension, and gout.

His current medications are:  
Metformin, 1000 mg twice daily
Allopurinol, 300 mg once daily
Aspirin, 81 mg daily
Pravastatin, 40 mg daily

Labs are drawn today and include:
HbA1c level, 6.8%
Complete metabolic panel: WNL (SCr, 0.7; Na+, 139; K+, 4.6; AST, 23; ALT, 26)
Uric acid, 5.7 mg/dL
Urine microalbumin/urine creatinine ratio, 4 mg/g

Vital signs: Weight, 72 kg
BMI, 28 kg/m2 Blood pressure in clinic today, 150/90 mmHg and 152/94 mmHg
Blood pressure average at last 3 clinic visits: 150/94 mmHg, 138/84 mmHg, 144/86 mmHg
Last 3 HbA1c measures in the past year: 6.9%, 6.4%, 6.6%

The patient has no known drug allergies, and he quit smoking 1 year ago.

DL receives a diagnosis of hypertension. He notes that he has been making lifestyle changes, specifically following the Dietary Approaches to Stop Hypertension (DASH) diet and increasing his exercise, since being told of his elevated blood pressure at previous visits starting 1 year earlier.

According to JNC8 guidelines, what would be the most appropriate first-line therapy for treating the patient’s hypertension?

A. Add metoprolol succinate, 25 mg daily
B. Add lisinopril, 10 mg daily
C. Add chlorthalidone, 25 mg daily
D. Add amlodipine, 5 mg daily
E. Encourage lifestyle modifications and continue current medications
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