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Tuesday, March 11, 2014
High Blood Pressure
a 67 years old female, obese, having arthritis, diagnosed recently to be hypertensive, taking atenolol 100 mg. regular monitoring indicates B.P almost always 200/100 mm of Hg. what to take now? has she developed resistance towards atenolol?
A blood pressure of 200/100 is extremely high and requires attention. Atenolol 100 mg is obviously inadequate, and it is likely that this patient will need two, three or four different drugs to control her high blood pressure.
A good first step would be to add a diuretic (a water pill), followed by addition of an ACE inhibitor (e.g. lisinopril), and if needed, a calcium channel blocker (e.g. amlodipine).
The goal blood pressure for this patient is probably 140/90 or lower, and a blood pressure of less than 130/80 would be optimal. If her blood pressure cannot be controlled with four medications, she will need a work-up for underlying causes of hypertension. She may need referral to a hypertension specialist, a cardiologist or a nephrologist.
Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati