M.S is a 65-year-old African American retired schoolteacher. She complains of left calf pain when walking a couple of blocks. She states the pain goes away after she rests for 5 minutes. M.S is requesting pain medication for her headache that she rates a 8 on a 1-10 pain scale. Her primary history includes: NSTEMI 20 months ago, carotid bruit, hypertension, type 2 diabetes, hyperlipidemia, and former smoker. She has a family history of diabetes and cardiovascular disease.
The current physical examination reveals BP: 142/92, HR: 80, RR: 28, height: 5’4”, weight: 180 lbs., left femoral bruit, carotid bruit, and bilateral reduced pedal pulses.
Current medications: ASA 81 mg/day; Ramipril 10 mg/day; Metformin 500 mg TID; Lovastatin 20 mg/day; Metoprolol 25 mg BID. M.S tells you she has not taken her blood pressure meds for several weeks because she can not afford them right now.
Current laboratory findings: A1C: 7.5%; Lipids at desired values; Complete blood count within normal limits; ECG normal.