CT is a 69-year-old white male with hypertension and a histo…

CT is a 69-year-old white male with hypertension and a history of chronic kidney disease and proteinuria.  Today he has a creatinine clearance of 48 mL/minute.  At his visit today he reports some new swelling in his ankles that has increased since his dose of amlodipine was increased. He reports that the edema limits his ability to put his shoes on and do work around the house.  He brings a month’s worth of home blood pressure readings, and the readings are as follows:                          SBP     DBP    HR Maximum:       158      94        64 Minimum:        138      80        55 Average:         143      84        59 Medications: Amlodipine 10mg daily Labs: Potassium: 4.0 mEq/L Creatinine clearance – 48 mL/minute Urinary Protein:creatinine ratio –   1477 mg/g  (< 300 mg/g) Which of the following would be the BEST plan to reduce his blood pressure AND hopefully reduce some of his amlodipine-induced edema?

TY is a 58-year-old female with a new diagnosis of hypertens…

TY is a 58-year-old female with a new diagnosis of hypertension. She has had two prior strokes and would like to prevent a third one.  She has an appointment in the family medicine clinic this morning where she reported the changes in lifestyle (increased exercise, lower sodium diet) she had been implementing over the past few months had not lowered her blood pressure significantly. Average blood pressure (home readings from past month):  138/80 mm Hg HR 60             Laboratory measurements (today):             Serum Sodium:  140 mEq/L (135-145)             Serum Potassium: 3.2 mEq/L (3.5-5.0 mEq/L)             Serum Creatinine:  0.9 mg/dL (0.6-1.1 mg/dL) Based on the ACC/AHA 2017 treatment guidelines, which (first-line) initial medication therapy would you recommend for her today?