A 70 years old male with diabetes mellitus and hypertension is treated with Ramipril 5 mg, Amlodipine 5 mg and disothiazide 25 mg. Despite the treatment his BP in repeated measurements were around 150-160/80-90 mmHg with heart rate of 80 beats per minutes. The elevated BP values were confirmed by 24H ABPM . Laboratory work-up: Bun = 30 mg/dL, Creatinine = 0.9 mg/dL, Na = 138 mmol/L, Potassium = 4.5 mmol/L. Which drug should be added to lower his BP?
What of the following is not typical to hypertension in diabetes mellitus?
A 70-year-old lady with diabetes mellitus and mild hypertension that is well controlled with Candesartan 16 mg was injured in a car accident. In the emergency room, no significant injury was found, but a very high blood pressure was measured, 190/80 mmHg, and a regular heart rate of 88. In the emergency room the laboratory work-up revealed Creatinine = 0.9 mg/dL, BUN = 30 mg/dL, Na = 137 mmol/L and K = 4.2 mmol/L. She received an addition of amlodipine 5 mg. The blood pressure dropped to 150/80 mm Hg and she was released for follow-up in the community. In the clinic, repeated blood pressure values were around 170-180/80-90 mmHg and the was pulse 76-84 beats/min. What is recommended for this patient?
