ANSWERS ON QUESTIONS

Main part

Patient K., 58 years old, suffers from arterial hypertension (BP - 175 / 105–160 / 95 mm Hg.

Art.). Notes an increase in blood pressure over 18 years. Constantly taking atenolol 50 mg a

day, hydrochlorothiazide 25 mg per day. Over the past ten years has gained 30 kg in weight.

Objectively: increased nutrition. Height - 158 cm, weight - 91 kg. Body mass index -

36.5 kg / m². Waist size - 120 cm, hip volume - 128 cm. Condition is satisfactory.

The skin is clean. There are no fathers. In the lungs, vesicular breathing, no wheezing. Tones

hearts are muffled, the rhythm is correct. Heart rate - 90 beats per minute. The stomach is soft

painless. Liver at the costal margin.

Biochemical analysis of blood: total cholesterol - 7.2 mmol / l; triglycerides -

3.12 mmol / L; HDL-C - 0.9 mmol / L; creatinine - 95.9 μmol / l; blood glucose

on an empty stomach - 6.3 mmol / l; 2 hours after ingestion of 75 g of glucose - 9.0 mmol / L.

Urinalysis: color - straw yellow, relative density - 1014,

transparent, acidic reaction, protein, sugar absent, white blood cells - single in the field

view.

Urinalysis for microalbuminuria - 200 mg / day.

GFR: 81.7 ml / min according to the Cockcroft-Gault formula.

ECG: sinus rhythm, heart rate - 70 beats per minute, left ventricular hypertrophy.

ECHO-KG: valvular pathology not detected, cardiac cavities not expanded, index

left ventricular myocardial mass - 121 g / m², signs of diastolic dysfunction, PV -

65%

Questions:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

3. Make and justify a plan for an additional examination of the patient.

4. What groups of antihypertensive drugs would you recommend to a patient in

composition of combination therapy? Is the beta

blocker and diuretic? Justify your choice.

5. After 6 months of regular antihypertensive therapy (combination

Amlodipine at a dose of 10 mg / day and a drug from the group of RAAS blockers (inhibitor

ACE or angiotensin II receptor antagonist) + Rosuvostatin 20 mg / day +

dieting - blood pressure within 120–130 / 70–80 mm Hg, fasting glucose - 5.4

mmol / L, total cholesterol - 5.0 mmol / L, TG - 1.8 mmol / L, HDL-C - 1.2

mmol / l, creatinine - 100 μmol / l, GFR (according to the Cockcroft-Gault formula) = 65.3

ml / min; albuminuria - 10 mg / day. What is your further therapeutic tactic?

Justify your choice.

Situational task 120 [K000458]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 43-year-old man consulted a local GP with complaints of

recurrent headache in the occipital region. Pain worries about

months against a busy schedule (night shifts), smokes about 20

years to 15 cigarettes a day. Headaches became more frequent during the last week, with

measuring blood pressure 150-160 / 90 mm RT. Art. Parents suffer from hypertension, father

at 45, he suffered a stroke.

Objectively: the condition is satisfactory. Body weight increased by

abdominal type, height - 172 cm, weight - 86 kg. Waist - 105 cm, Hip - 92

see. There are no fathers. Auscultatory: breathing over the lungs is vesicular, no wheezing. BH - 18

in minutes Heart sounds are clear rhythmic, percussion borders of relative dullness of the heart

within normal limits. HELL - 150/90 mm RT. Art., heart rate - 92 beats per minute. The stomach is soft

painless, liver along the edge of the costal arch. Symptom of lumbar striking

negative, there are no dysuric phenomena. The chair is normal.

Clinical blood test: hemoglobin - 145 g / l; erythrocytes - 4.9 × 10 12 / l;

white blood cells - 7.0 × 10 9 / l; ESR - 15 mm / hour.

Urinalysis: relative density - 1018, protein - no, in urine

leukocyte sediment - 2-4 in the field of view.

Biochemical blood test: total cholesterol - 5.3 mmol / l, uric acid -

500 μmol / L, creatinine - 78 μmol / L, fasting glucose - 5.8 mmol / L.

Microalbuminuria: 25 mg / day.

ECG: sinus rhythm, signs of LV myocardial hypertrophy, focal changes

not.

Questions:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

3. Make and justify a plan for an additional examination of the patient.

4. What groups of antihypertensive drugs would you recommend to a patient in

composition of combination therapy? Justify your choice.

5. After 6 months of regular antihypertensive therapy (combination

Amlodipine at a dose of 5 mg / day and ACE inhibitor Enalapril 20 mg / day) +

compliance with the diet - blood pressure in the range of 120–130 / 70–80 mm RT. Art., uric acid - 300

μmol / l, creatinine - 78 μmol / l; albuminuria - 0 mg / day. What is your

further treatment tactics? Justify your choice.

Situational task 121 [K000459]