A 31 year-old woman has been followed by you for three years and has had recent onset of hypertension. She is still not at goal
despite three antihypertensive medicines and you strongly doubt non adherence. Her father died of a heart attack at age 58. Today her pressure is 168/94 and pressure on the other arm is similar. Which of the following would be the most appropriate plan?
The Question is not complete . But if I am to be the physician I will increase the strength /dosage of the 3 antihypertensive example:
. If the patient is on this combination Amlodipine (as besylate), valsartan, hydrochlorothiazide; 5mg/160mg/12.5mg , I will increase the dosage gradually to 5mg/160mg/25mg, for the next 2 weeks to see if there is any significant drop in blood pressure, if it remains same , another graduate increase in strength will be done.
Likely the chronological age, mainly because it would explain the differences in puberty stages between the two boys, which is an example of physical maturation.
