Patient Case

A 58 year old obese African American female, with a long history of poorly controlled HTN presents to the clinic today for routine follow-up on her blood pressure.

She had an echo 2 years ago that showed moderate concentric left ventricular hypertrophy and evidence of diastolic dysfunction, but no valvular abnormalities with a normal LV systolic function. She has Type 2 DM and dyslipidemia. Her renal function has historically been normal. She has no symptoms today but is frustrated that her blood pressure is not well controlled, despite her continued compliance with the number of medications she is taking. She states her medication costs are “out of sight”. She insists she has been adhering to her low-sodium diet. Her current medications include:

Lisinopril 40mg daily

HCTZ 50 mg daily

ASA 325 daily

Metformin 1000mg PO BID

Simvastatin 40 mg daily.

Her physical exam reveals she is well nourished, well developed and in no apparent distress. BP today is 160/90, HR 88, Resp 20. She is afebrile. Her BMI is 34 with her weight being stable since her last visit 3 months ago. HgbA1c is 7.8. Total cholesterol is 290, HDLc is 50, LDLc is 71, and triglycerides are 125. Potassium is 4.4, BUN is 19, and creatinine is 1.2.

Question:

What medication would you prescribe to help control her blood pressure, while addressing her concern about the cost of her medications? Provide rationale for your decisions, considering drug interactions and all diagnoses.