What could M.P. be doing that is causing her nocturia? What ...

[geoffrey]

What could M.P. be doing that is causing her nocturia?
 
  What will be an ideal response?

Question 2

M.P. is a 65-year-old African American woman who comes to your clinic for a follow-up visit. She was diagnosed with hypertension (HTN) 2 months ago and was given a prescription for a thiazide diuretic but stopped taking it 2 weeks ago because
 
  it made me dizzy and I kept getting up during the night to empty my bladder. During today's clinic visit, she expresses fear because her mother died of a cerebrovascular
  accident (CVA, stroke) at M.P.'s age, and M.P. is afraid she will suffer the same fate. She states, I've never
  smoked and I don't drink, but I am so afraid of this high blood pressure. You review the data from her past
  clinic visits.
 
  Family History
  Mother, died at age 65 years of CVA
  Father, died at age 67 years of myocardial infarction (MI)
  Sister, alive and well, age 62 years
  Brother, alive, age 70 years, has coronary artery disease (CAD), HTN, type II diabetes
  mellitus (DM)
  Patient Past History
  Married for 45 years, two children, alive and well, six grandchildren
  Cholecystectomy, age 42 years
  Hysterectomy, age 48 years
  Blood Pressure Assessments
  January 2: 150/92
  January 31: 156/94 (Given prescription for hydrochlorothiazide HCTZ 25 mg PO every
  morning)
  February 28: 140/90
 
  According to the most recent guidelines from the Joint National Committee on Prevention,
  Detection, Evaluation, and Treatment of High Blood Pressure, M.P.'s blood pressure (BP)
  falls under which classification?

[Eazy416]

Answer to Question 1

She could be taking the HCTZ in the late afternoon or evening, instead of in the morning. Diuretics,
such as HCTZ, should be taken in the morning so that the diuretic effects do not disturb sleep.

Answer to Question 2

Stage 1 hypertension (defined as systolic BP from 140 to 159 mm Hg or diastolic BP from 90 to 99 mm
Hg) on each of two or more office visits. Instructors may refer to the guidelines, the most recent
information from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment
of High Blood Pressure (JNC 9).

[geoffrey]

Excellent

[mohan]

TYSM