Sentry Page Protection

MMI Scenario 27


Mr Williams is a 58-year-old Caucasian man and he has recently had a medical check-up at his GP clinic. His blood pressure was 158/96 and BMI is 28kg/m2. When seeing him for a review, he tells you that he drinks five units of alcohol daily, doesn’t exercise much and eats out a lot due to the nature of his work. His ambulatory blood pressure results show that on average the daytime readings are 164/84 mmHg and night-time readings are 150/79 mmHg. He has a CVD risk of 21% (calculated from QRISK-3). Explain the key points that you would want to discuss with this patient.
​

Example Answer
​

Hypertension: Explain to the patient that he has hypertension and ensure he understands what this means and what value would be regarded as within range for his age (ABPM < 135/85). Additionally, it would be prudent to mention the long-term complications of poorly controlled hypertension, including increased risk of kidney, eye and small vessel disease. With the raised blood pressure, and the gentleman’s age, a CCB such as Amlodipine would likely be the most appropriate medication to commence.

QRISK: Explain what his QRISK score means in terms of his risk of CVD (risk of stroke, heart attack and vascular disease). Given that the QRISK is > 10%, it would be advisable to consider commencing a statin and regularly monitoring the cholesterol and liver tests.

Lifestyle Optimisation: Discuss opportunities to manage high blood pressure by specifically addressing his diet, weight loss, exercise, smoking and alcohol (< 14 units/week).

Follow-Up: Given the number of issues to address, it would be important to arrange a follow-up meeting to address any outstanding concerns, as well as ensuring that each of the issues have been appropriately addressed.
​