Value: 100 points
Due: Day 7
Rachel Jones, a 63-year-old woman (weight 184 lb.), is a new patient referred to your primary care clinic. Her medical history includes type 2 diabetes mellitus (diagnosed in 2016), hypertension (diagnosed in 2012), and CKD3 with albuminuria (diagnosed in 2018). Ms. Jones is also a former smoker (quit in 2010).
Ms. Jonesâ€™ current medications include:
A baseline lipid panel returns with the following results:
Renal function test results include eGFR of 53 mL/min/1.73m2 and urine albumin-to-creatinine ratio of 74 mcg/mg. Ms. Jonesâ€™ BP today is 155/74 mm Hg and pulse 76 bpm. Her calculated 10-year ASCVD risk is 13.2%.
Part A: Which one of the following diabetes-specific risk enhancers do you think is the most relevant when initiating high-intensity statin therapy in Ms. Jones? Explain not only your decision, but also why the other choices are not as relevant. Please use the textbook, as well as any relevant guidelines or primary literature, to formulate your selection and explain your answer.
Part B: You decide to initiate high-intensity statin therapy for Ms. Jones. Address each of the following:
LDL Blood Work Target Choices:
Part C: Ms. Jonesâ€™ blood pressure is again high today when you see her in clinic. You check her home blood pressure monitoring log and see that her blood pressure fluctuates between 142-161/74-91, indicating poor control. You ask Ms. Jones if she has been compliant with her medications. She states she has been, but may have missed 3-4 doses per month. You note Ms. Jones is currently taking Lisinopril/HCTZ 20/12.5 mg.
Discuss Ms. Jonesâ€™ current hypertension regimen and explain what changes (if any) you would make and why. In addition to the textbook, please use the current AHA hypertension guidelines as a reference(s).
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