Question

A 62-year-old woman with a 10-year history of type 2 diabetes attends for review. She is a non-smoker. Her current medications are metformin, atorvastatin and low-dose ramipril 2.5 mg once daily started for nephroprotection. On three recent visits, her standardized office blood pressure readings are 138/82, 142/84 and 140/86 mmHg. Her urinary albumin-to-creatinine ratio is 4.0 mg/mmol (elevated), estimated GFR is 70 mL/min/1.73 m², and HbA1c is 7.3%. According to Canadian guidelines, what is the most appropriate blood pressure management strategy?

Accepted Answer

Increase ramipril to a maximally tolerated dose to achieve a target blood pressure <130/80 mmHg.

Answer

Her blood pressure is at target; no change in antihypertensive therapy is required.

Answer

Stop ramipril and switch to a thiazide diuretic as first-line therapy.

Answer

Add a beta blocker as second-line therapy to achieve a target blood pressure <140/90 mmHg.

Answer

Defer changes to antihypertensive therapy and focus solely on tighter glycaemic control.

Practice question