Question of the Week # 173

173) A 52 year old African-american woman is seen in the office during a regular follow-up visit. Her history is significant for diabetes mellitus and hypertension. Her medications include Aspirin, Glipizide, atorvastatin and losartan. She states that she stopped taking diuretic because it increased her frequency of urination that it interfered with her active lifestyle.

On examination, blood pressure is 152/94 mm Hg seated and standing.  Her physical examination is normal.  Laboratory values reveal microalbuminuria  of 250mg/24hours and a serum creatinine concentration of 1.3mg/dl. Based on the findings above, her blood pressure medications should be optimized to achieve which of the following targets?

A)     < 140/90

B)      < 135/85

C)      <130/80

D)     <120/70

E)      <130/90

9 Responses

  1. ccccccccc

  2. I know there is a criterior for this answer. And it changes every year

    I will say,without being too aggressive 130/80. If its wrong it was right 1 year ago

  3. supposed to be 125/75….so C

  4. c

  5. <130/80

  6. C) <130/80

    125/75 in Diabetic Nephropathy with microalbuminuria

  7. diabetes is equivalent to CAD, so I would target 120/70.

  8. K/DOQI Clinical Practice Guidelines on Hypertension and Antihypertensive Agents in Chronic Kidney Disease

    GUIDELINE 8: PHARMACOLOGICAL THERAPY: DIABETIC KIDNEY DISEASE

    Diabetes mellitus is the most common cause of kidney failure in the United States. Diabetic kidney disease is characterized by the early onset of albuminuria, hypertension, and a high risk of coexistent or subsequent CVD.

    8.1 Target blood pressure in diabetic kidney disease should be <130/80 mm Hg (see Guideline 7) (Table 104).

    8.2 Patients with diabetic kidney disease, with or without hypertension, should be treated with an ACE inhibitor or an ARB (Table 104).

  9. JNC 8 says <140/90 …so A?

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