“blood pressure control

DM is a 62 year old white female who presents to the cardiologist following referral from her primary care physician for “blood pressure control.” Her medical history is significant for type 2 diabetes (T2DM), hyperlipidemia, osteoarthritis, obesity (Ht=5’3”; weight=180 lbs; BMI=31.9), and she is post-menopausal.

She is a non-smoker with some alcohol use (3-5 glasses of red wine/week). She gets some exercise by walking to and from work daily in which she breaks a sweat (roundtrip 3 miles). The walk usually takes about 30 minutes.

Medications:
100 units insulin detemir QPM
insulin aspart titrated before meals & snacks
Isradipine CR 20mg QD x 6 months
Valsartan 80mg QD x 3 months
Pravastatin 40mg QD
Piroxicam 10mg QD prn pain
Raloxifene 60mg QD
Multivitamin 1 tablet daily
Calcium supplements up 1200mg/day
Vitamin D 800 – 1,000 units/day

Fasting labs:
Na+= 150 mEq/L
K+= 4.8 mEq/L
Cl= 110 mEq/L
HCO3= 24 mEq/L
BUN= 18 mg/dL
Cr= 1.4 mg/dL
Glucose = 100 mg/dL
HbA1c = 6.5%
LFTs= WNL
LDL-C= 95 mg/dL
HDL = 50 mg/dL
Triglycerides = 90 mg/dL
Total cholesterol = 178 mg/dL

Her blood pressure is 180/90.

Question

Does DM have resistant HTN or uncontrolled HTN and how should it be managed?

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