A 54-year-old man presents to the outpatient clinic for management of his blood pressure. He reports feeling well and does not have any complaints. Medical history is significant for hypertension and stage 4 chronic kidney disease with proteinuria that has been quantified at ≥3.5 g/day. The patient states he is compliant with his current medications which are lisinopril and nifedipine. He reports eating a “heart healthy diet.” He is afebrile with a blood pressure of 152/90 mmHg, heart rate of 78 beats/min, respirations of 18/min, and a body mass index (BMI) of 29 kg/m2. Physical examination shows jugular venous distension of > 4 cm above the sternal angle. Cardiac examination reveals an S4 that occurs during late diastole. Lungs are clear to auscultation without wheezing or crackles. There is 1+ bilateral pitting edema in the lower extremities. The remainder of the examination is otherwise unremarkable. Laboratory studies reveal the following:
- Sodium: 137
- Potassium: 5.1
- Chloride: 94
- Bicarbonate: 22
- BUN: 21
- Creatinine: 2.6
- eGFR: 25
- Glucose: 124
- Calcium: 8.2
Which of the following is the most appropriate additional medical therapy according to the current American College of Cardiology / American Heart Association (ACC/AHA) blood pressure guidelines?
- A) Candesartan
- B) Chlorthalidone
- C) Furosemide
- D) Hydralazine
- E) Metoprolol succinate
Author(s)
Dr. Raj Dasgupta
Editor(s)
Dr. Raj Dasgupta
Last updated
Oct 16, 2024
