Mr.White is 62 years old and has chronic kidney disease that has been relatively stable.He also has a history of hyperlipidemia,osteoarthritis,and hypertension.He is compliant with his medications,and his BP has been well controlled on a calcium channel blocker.His last lipid panel showed: TC = 201,HDL = 40,TG = 180,LDL = 98.He currently takes Crestor 20 mg daily.In the office today,his BP is 188/90,and his urine dip now shows significant proteinuria.He denies any changes in his dietary habits or medication regimen.What would be the best medication change for Mr.White at this point?

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Quizplus · Accepted Answer

Mr. White's significant proteinuria and hypertensive urgency (BP of 188/90) suggest that he may have developed renal disease progression or renal artery stenosis. Changing his calcium channel blocker to an ACE-I is the best option in this case, as ACE-Is have been shown to have renal protective effects and can slow the progression of renal disease. Additionally, ACE-Is are preferred over calcium channel blockers for patients with proteinuria. Increasing the dose of the Crestor or calcium channel blocker would not address his current issue. Waiting 4 weeks for a re-check is not appropriate for his level of urgency.

MrWhite Is 62 Years Old and Has Chronic Kidney Disease