{"id":41152,"date":"2014-01-22T10:53:45","date_gmt":"2014-01-22T15:53:45","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&#038;p=41152"},"modified":"2014-02-01T22:20:30","modified_gmt":"2014-02-02T03:20:30","slug":"prevention-guidelines-in-practice-vignette-1","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2014\/01\/22\/prevention-guidelines-in-practice-vignette-1\/","title":{"rendered":"Prevention Guidelines in Practice: Vignette 1"},"content":{"rendered":"<p><i>This vignette is the first in our series \u201c<a href=\"http:\/\/blogs.nejm.org\/cardioexchange\/voices\/series-making-sense-of-the-new-prevention-guidelines-the-view-from-clinical-practice\/\">Making Sense of the New Prevention Guidelines \u2014 The View from Clinical Practice<\/a>\u201d<b><br \/>\n<\/b><\/i><\/p>\n<p>I received this email from a 71-year-old gentleman in Utah who takes lisinopril 40 mg daily for hypertension and has never experienced an adverse event. He is a nonsmoker, exercises regularly, and has a normal body-mass index. He attached to the email a log of his systolic BP results, which have ranged from 130 to 151 mm Hg. Here is an excerpt from his message:<\/p>\n<blockquote><p>I would like to get your reaction to the <a href=\"http:\/\/jama.jamanetwork.com\/article.aspx?articleid=1791497\">new BP guidelines just published in JAMA<\/a>. \u2026I am quite confident that I could keep my systolic under the new guideline of 150 without medication. Please see my attached log \u2014 this morning it was 126.\u00a0The side effects of a dry throat are bothersome and interfere with my sleep on occasion. I would like to propose that I cut my [lisinopril] dose in half to 20 mg\/day, if not eliminate it all together.<\/p><\/blockquote>\n<ul>\n<li><strong>How would you respond to this patient?<\/strong><\/li>\n<li><strong>Have the guidelines and the related debate influenced how you counsel your patients and conduct your practice?<\/strong><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>A 71-year-old man asks John Ryan about reducing or stopping his hypertension medication<\/p>\n","protected":false},"author":280,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,1658,7],"tags":[454,2134,612,202],"class_list":["post-41152","post","type-post","status-publish","format-standard","hentry","category-general","category-hypertension-3","category-prevention","tag-hypertension","tag-jnc-8","tag-patient-physician-interaction","tag-practice-guidelines"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/41152","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/280"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=41152"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/41152\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=41152"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=41152"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=41152"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}