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Tuesday, July 13, 2010

Targeted BP for DM and Renal Failure Patient

A 57-year-old woman is evaluated in the office for intermittent claudication of the left calf that she has had for 5 years. The symptoms reproducibly occur after she walks 100 yards and resolve after 5 minutes of rest. The patient has an 80-pack-year smoking history but no longer smokes; she also has hypertension, type 2 diabetes mellitus, hypercholesterolemia, and chronic stable angina. Her medications are atenolol, atorvastatin, lisinopril, low-dose aspirin, and glyburide.

On physical examination, the blood pressure is 142/94 mm Hg in both upper extremities, and heart rate is 66/min. Carotid artery pulsations are brisk, with a right carotid artery bruit. The lungs are clear. Cardiac examination discloses an S4. There is a left femoral artery bruit with absent pulses in the left foot and trace pulses in the right foot.

Which of the following is the maximum acceptable blood pressure limit in this patient?
A <140/90 mm Hg
B <140/85 mm Hg
C <130/90 mm Hg
D <130/80 mm Hg

Answer and Critique (Correct Answer = D)

Key Point
The target blood pressure for patients with diabetes mellitus or renal failure is <130/80 mm Hg.

Hypertension is an independent risk factor for peripheral artery disease, and current guidelines support aggressive blood pressure management. For the general population, a blood pressure target of <140/90 mm Hg is associated with a decrease in cardiovascular complications, and a target pressure of <130/80 mm Hg is indicated for patients with diabetes mellitus (such as this patient) or renal failure.

1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560-72. [PMID: 12748199] [PubMed]

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