MKSAP: 38-year-old pregnant woman with hypertension and diabetes

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old woman is evaluated during a follow-up visit. She has a history of well-controlled hypertension and type 1 diabetes mellitus. She is at 16 weeks’ gestation with her first pregnancy. Prior to conception she was taking lisinopril, which was discontinued in anticipation of the pregnancy, and labetalol was initiated. Other medications are insulin glargine, insulin lispro, and a prenatal vitamin. On physical examination, she appears in good health. Blood pressure is 135/80 mm Hg. There is no edema. The remainder of the physical examination is normal. Laboratory studies reveal a serum creatinine level of 0.7 mg/dL (61.9 µmol/L) and a urine protein–creatinine ratio of 0.8 mg/mg. Which of the following is the most appropriate step in the management of this patient’s hypertension? A: Add methyldopa B: Change labetalol to losartan C: Increase labetalol dose D: Continue current medication regimen Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Diabetes Heart OB/GYN Source Type: blogs