MKSAP Quiz: intermittent claudication
MKSAP Quiz: intermittent claudication
A 57-year-old woman is evaluated for intermittent claudication of the left calf that she has had for 5 years. The symptoms reproducibly occur after she walks 100 yards and resolve after 5 minutes of rest. The patient has an 80 pack-year smoking history but no longer smokes; she also has hypertension, type 2 diabetes mellitus, hypercholesterolemia, and chronic stable angina. Her medications include atenolol, atorvastatin, aspirin, lisinopril, and insulin.
On physical examination, the blood pressure is 142/94 mm Hg bilaterally and heart rate is 66/min. Carotid arteries are brisk, with a right carotid artery bruit. The lungs are clear to auscultation and percussion. There is an S4 and nonradiating 2/6 early systolic murmur at the left lower sternal border. Examination of the abdomen is normal. There is a left femoral artery bruit, with absent pulses in the left foot and trace pulses in the right foot.
What is the target blood pressure in this patient?
A. <140/85 mm Hg
B. <140/90 mm Hg
C. <130/90 mm Hg
D. <130/80 mm Hg
MKSAP Answer and Critique
The correct answer is D) <130/80 mm Hg. This item is available online to MKSAP 14 subscribers in the Cardiovascular section, Item 118.
Hypertension is an independent risk factor for peripheral artery disease, and current guidelines support aggressive blood pressure management. For the general population, blood pressure targets of <140/90 mm Hg are associated with a decrease in cardiovascular complications, with target pressures of <130/80 mm Hg in patients with diabetes or renal failure.
Lifestyle modification (weight reduction, potassium- and calcium-rich diet, sodium restriction, physical activity, moderation of alcohol consumption) may all contribute to blood pressure control. Thiazide-type diuretics should generally be used as initial therapy for most patients with hypertension, either alone or in combination with an angiotensin-converting enzyme inhibitor, an angiotensin receptor blocker, a ß-blocker, or a calcium-channel blocker.
Key Point
- The target pressure for patients with diabetes mellitus or renal failure is <130/80 mm Hg.