A 70-year-old man presents with exertional chest pain and a positive exercise tolerance test. He refuses to undergo an angiogram and is discharged with a medication regimen consisting of aspirin 75 mg od, simvastatin 40 mg on, atenolol 50 mg od, and a GTN spray prn. Upon examination, his pulse is 72 bpm and his blood pressure is 130/80 mmHg. During follow-up, he continues to frequently use his GTN spray. What is the most appropriate course of action for his management?
A 45-year-old woman comes to you with sudden leg swelling after starting nifedipine for her consistently high blood pressure. She appears distressed and informs you that she is already taking 10 mg of ramipril daily. You discontinue nifedipine and record her intolerance in her medical history. Upon further inquiry, you discover that she had previously experienced leg swelling with amlodipine and a rash with verapamil. Unfortunately, her blood pressure rises again after discontinuing amlodipine. What alternative medication can be prescribed next?
A 38 year old, asymptomatic man is incidentally found to have a clinic blood pressure reading of 148/92 mmHg. His GP requests ambulatory blood pressure monitoring (ABPM) to confirm a diagnosis of hypertension. The average ABPM is found to be 144/90 mmHg. He has no significant past medical history and takes no regular medication. Urine dip is negative. His BMI is 35 kg/m². Appropriate further management in this case would be to:
You have a scheduled telephone consultation with Mrs. O’Brien, a 55-year-old woman who has been undergoing BP monitoring with the health-care assistant. The health care assistant has arranged the appointment as her readings have been consistently around 150/90 mmHg. Upon reviewing her records, you see that she was prescribed amlodipine due to her Irish ethnicity, and she is taking 10 mg once a day. Her only other medication is atorvastatin 20 mg. The health care assistant has noted in the record that the patient confirms she takes her medications as directed.
As per NICE guidelines, what is the next step in managing hypertension in Mrs. O’Brien, taking into account her ethnic background?
A 55-year-old man has been diagnosed with stage one hypertension without any signs of end-organ damage. As a first step, he is recommended to make lifestyle changes instead of taking medication.
What are the most suitable lifestyle modifications to suggest?
During his annual health review, a 67-year-old man with type 2 diabetes, hypercholesterolaemia, and hypertension is taking metformin, gliclazide, atorvastatin, and ramipril. His recent test results show a Na+ level of 139 mmol/L (135 – 145), K+ level of 4.1 mmol/L (3.5 – 5.0), creatinine level of 90 µmol/L (55 – 120), estimated GFR of 80 mL/min/1.73m² (>90), HbA1c level of 59 mmol/mol (<42), and urine albumin: creatinine ratio of <3 mg/mmol (<3). What is the recommended target clinic blood pressure (in mmHg)?
You assess a 79-year-old male patient’s hypertensive treatment and find that his current medication regimen of losartan and amlodipine is not effectively controlling his blood pressure. What would be the most suitable course of action, assuming there are no relevant contraindications?
A 44-year-old woman has been released from the nearby stroke unit following a lacunar ischaemic stroke. She has a history of hypertension and is a smoker who is currently taking lisinopril. However, her discharge medications do not include a statin. What would be the most suitable prescription for initiating statin therapy?
Mrs. Lee attends for her annual medication review. She is on tamsulosin and finasteride for benign prostatic hypertrophy, and paracetamol with topical ibuprofen for osteoarthritis. She says that she was offered treatment for her high cholesterol level at her previous medication review which she declined, but she has decided she would like to start one now after doing some reading about it. It had been offered for primary prevention as her estimated 10-year cardiovascular risk was 22%.
Her blood results are as below.
eGFR 62 mmol/L (>90 mmol/L)
Total Cholesterol 6.6 mmol/L (3.1 – 5.0)
Bilirubin 10 µmol/L (3 – 17)
ALP 42 u/L (30 – 100)
ALT 32 u/L (3 – 40)
γGT 55 u/L (8 – 60)
Albumin 45 g/L (35 – 50)
What medication should be prescribed for Mrs. Lee?
A 48-year-old man presents to your clinic with concerns about his risk of coronary heart disease after a friend recently suffered a heart attack. He has a history of anxiety but is not currently taking any medication. However, he is a heavy smoker, consuming around 20 cigarettes a day. On examination, his cardiovascular system appears normal, with a BMI of 26 kg/m² and blood pressure of 126/82 mmHg.
Given his smoking habit, you strongly advise him to quit smoking. What would be the most appropriate next step in managing his risk of coronary heart disease?