Instructions
You are a medical student on placement in general practice. Carmela Caruso, 56, is here for the results of her blood pressure tests. They are below.
Take a focused history
Explain the results and your management plan to the patient
Today
BP 156/94 (seated, average of two); BMI 29; waist 94 cm
Blood pressure record, bloods and ECG
| Item | Value | Reference range |
|---|---|---|
| Clinic blood pressure, visit 1 (4 weeks ago) | 158/96 mmHg | <140/90 mmHg |
| Clinic blood pressure, visit 2 (2 weeks ago) | 156/94 mmHg | <140/90 mmHg |
| Home blood pressure, 7-day average (28 readings, validated upper-arm cuff) | 152/94 mmHg | <135/85 mmHg |
| Sodium | 139 mmol/L | 135-145 mmol/L |
| Potassium | 4.2 mmol/L | 3.5-5.0 mmol/L |
| Creatinine | 70 umol/L | 45-90 umol/L |
| eGFR | 88 mL/min/1.73m2 | >60 mL/min/1.73m2 |
| Urine albumin-creatinine ratio | 1.2 mg/mmol | <3.5 mg/mmol |
| Fasting glucose | 5.4 mmol/L | 3.5-5.4 mmol/L |
| Total cholesterol | 6.1 mmol/L | <5.5 mmol/L |
| LDL cholesterol | 3.9 mmol/L | <2.0 mmol/L |
| HDL cholesterol | 1.4 mmol/L | >1.0 mmol/L |
| Triglycerides | 1.6 mmol/L | <2.0 mmol/L |
| ECG | Sinus rhythm 74 /min; normal axis; no left ventricular hypertrophy; normal | Normal |
Non-smoker. No diabetes. Australian CVD risk calculator: approximately 7% risk of a cardiovascular event over 5 years (intermediate risk).