January 22nd, 2014
Prevention Guidelines in Practice: Vignette 1
This vignette is the first in our series “Making Sense of the New Prevention Guidelines — The View from Clinical Practice”
I received this email from a 71-year-old gentleman in Utah who takes lisinopril 40 mg daily for hypertension and has never experienced an adverse event. He is a nonsmoker, exercises regularly, and has a normal body-mass index. He attached to the email a log of his systolic BP results, which have ranged from 130 to 151 mm Hg. Here is an excerpt from his message:
I would like to get your reaction to the new BP guidelines just published in JAMA. …I am quite confident that I could keep my systolic under the new guideline of 150 without medication. Please see my attached log — this morning it was 126. The side effects of a dry throat are bothersome and interfere with my sleep on occasion. I would like to propose that I cut my [lisinopril] dose in half to 20 mg/day, if not eliminate it all together.
- How would you respond to this patient?
- Have the guidelines and the related debate influenced how you counsel your patients and conduct your practice?