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MMI Scenario 21


Mr. Desmond is a 70 year old Afro-Caribbean man with a family history of cardiovascular disease. He was diagnosed with hypertension in the last two months and was initiated on amlodipine 5mg. His blood pressure is gradually coming down, however, he has noticed that his ankles have become increasingly swollen recently. He has not changed his lifestyle much and loves to add salt to his food with every meal, even though he was advised to cut this down on his last visit. What advice would you give Mr. Desmond and what discussion would you have with his GP regarding his medication? 
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Example Answer
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Patient Understanding: Check that Mr. Desmond understands the importance of reducing salt in his diet and the implications this may have on his blood pressure. Additionally, it would be important to check Mr. Desmond’s understanding of his family history of CVD and the impact his hypertension diagnosis has on the risks of future cardiovascular events.

Lifestyle Factors: Discuss with the patient how he may make changes to his lifestyle to prevent CVD, including diet and exercise.

Side Effects: Explain the causes of ankle swelling as a side-effect of amlodipine and include him in the decision to modify his treatment.

Medication Optimisation: Recommend a second-line option of treatment and explain the benefits of this treatment. Check that the patient understands and agrees with the management plan.
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