Case 3: to treat or not to treat hypertension?


Clinical case:

Ms Sara Brandenberg is a 55-year-old woman who attends her GP practice for routine health screening. She has previously been fit and well. She was born in the UK, her father is Swiss and her mother Jamaican.

The practice nurse measures her BP at 160/100mmHg. Ambulatory blood pressure monitoring is performed, which provides a mean reading of 138/88mmHg. She is not diabetic, and smokes 10 cigarettes/day.

His observations are:

  • Temperature: 37.2 C, pulse rate 81bpm, RR 14, GCS 15, BP 160/10mmHg, BM 6.1mmol/L, Sats 99% on air.

Examination shows:

  • A: airway clear
  • B: RR 14, air entry bilaterally, no crepitations or wheeze
  • C: normal volume pulse, well perfused, capillary refill time of less than 2 seconds, apex beat in 5th intercostal space midclavicular line, heart sounds normal, no heaves or thrills
  • D: orientated, alert, pupils equal and reactive, fundoscopy no evidence of retinopathy
  • E: abdomen soft, non-tender, no organomegaly, bowel sounds present

Investigations reveal:

  • ECG: sinus rhythm, no left ventricular hypertrophy by electrical criteria
  • Urinalysis: no microalbuminuria detected
  • Bloods: Urea = 4.5mmol/L, Creatinine = 65μmol/L, Blood glucose = 5.6mmol/L, HbA1c = 40mmol/mol (5.4%)
  • Lipid profile: Total cholesterol = 6.5mmol/L,  LDL = 5.3mmol/L,  HDL = 0.8mmol/L

Question: Should Ms Brandenberg’s blood pressure be treated, and if so with which drug(s)?   

Discuss now on Twitter, using the hashtag #quclms. Follow @quclms for updates.

Question setter and expert: Dr Daniel Marks, Clinical Pharmacologist at UCLH and Wellcome Postdoctoral Research Fellow in Molecular Medicine



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