Hypertension in an African American Man with Diabetes

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.