A.B. is a 45-year-old African American male who presents for a follow-up on his diabetes

A.B. is a 45-year-old African American male who presents for a follow-up on his diabetes. He reports to have lost a few pounds but is finding it difficult to control his diet.

Past medical history: Type 2 diabetes mellitus x 4 years

Social history: Married for 20 years. Current a smoker of 20 pack years. Socially drinks beer on the weekends. He has three children. He does not routinely exercise. Works at the USPS in the maintenance of vehicles.

Medications: Metformin 1000 mg bid

Physical exam:

BP: 134/84

Pulse: 76

Weight: 220lb

Height: 71”

BMI: 30.9%

Recent Lab. Results:

HgA1C 7.6%, Cholesterol 178 mg/dL, HDL 45 mg/dL, LDL 90 mg/dL

How do you assess the patient’s BP? What would help your decision to go with pharmacologic therapy versus non-pharmacologic therapy?
What are the non-pharmacologic therapy components that would help A.B.?
If you decide to go with pharmacologic therapy what would be your first-choice drug, and what would be your BP goal for A.B.?
At this stage, does the patient need any drugs considering his lipid profile?
What are the measures you should take as primary prevention of cardiovascular disease in this patient?

 

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