Lim
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45 yo previous normotensive male, BP 165/92 multiple BP over 2-3 times confirms HTN, 1PPD smoking for 30 years, otherwise no artherosclerotic heart disease risk factors, PE and all labs unremarkable. What's the best initial step in his treatment?
a) smoking cessation
b) start medication immediately
what makes starting hypertensive medication immediately after diagnosis?
risk factors? in most questions ... male,>55yo,smoking .so they have 3 major risk factors.. so even though their BP is less than 140. should we start medication?
as far as I know...pt. systolic BP is over 160..at first visit.
take his/her bp in a month..and then confirm the diagnosis ..and start medication.
isn't correct?
thanks in advance.
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| neuroblastoma
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Person having sustained BP>140/>90 SHOULD be treated with meds.
130-139--lifestyle modification
((male,>55yo,smoking .so they have 3 major risk factors.. so even though their BP is less than 140. should we start medication? )) life style modification-try to reduce risk factors
((as far as I know...pt. systolic BP is over 160..at first visit. ))..>>treatment + follow up within 1 month.
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| Lim
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thank you,neuroblastoma.
so you think the answer is b?
i asked cause Dr. Asher Kornbluth taught it's A in his 2002 kaplan lecture.
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| elitoki
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You must start with smoking cessation.
All essential HTN pt should have to start with life style modification for least 6mo. and then give medication.
BP less than 140/90 ( 135/85) is clasified as predisposition to htn so they have to begin with life style to prevent posteriorly HTN.
Let me know if I'm wrong.
Edited by elitoki on 08/28/07 - 09:30 AM
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| neuroblastoma
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intial step is STOP smoking..
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| neuroblastoma
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we start meds when the BP is sustained high. if doctor has checked it twice thrice-on different visits.- >140
but on first visit--initial step is--STOP smoking.
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| lakshya_0_7
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ANSWER IS A according to me...i'll start with medications straightaway only if i find diastolic BP more than 100.....or an old pt with isolated systolic HTN meaning.....systolic BP-more than 160 with diasolic less than 90....
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| Lim
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thanks you guys...
when i see a (real) patient in a clinic, i usually start to medication for them. (165/92, two or third visits in a row)
in fact..i did kind of done not-right-treatment for them? 
Try to stop smoking for at least 6 months,what if he got into CVA(hemorrhagic)
HTN and smoking, does he have two risk factors for CVA?
hm.... on knowledge based, try to stop smoking first, ok.
lakshya_0_7, thanks for your good tip.
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| doyoudig
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Pts Diastolic Pressure is < 100 - Mild - Mod HTN hence 1st try Lifestyle meds, in addition pt has no RF for CAD
so I'd go with A 1st
but kaplan does not mention smoking cessation as part of lifestyle change for HTN?
what the source of this question? and do u have an answer?
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| Lim
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i already posted the source(kaplan lecture). and the answer is a i already told you.
when bp goes up isn't it "OR"? not and? ex 160 or 100 like this.
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| liliaeliz
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stage 1 140-159/90-99) and stage 2 (>= 160/100) you start drugs and allways you pick up the most elevate BP
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| neuroblastoma
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hey lim in question u already mentioned
previous normotensive male, so it means its his first time he got 165/92..so ask him to stop smoking.
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