section 2 (answers)

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5 years later he returns to see you in surgery complaining of headaches which are not relieved by simple analgesics.

His blood pressure is found to be elevated and averages 180/110 mmHg having been checked on 3 separate occasions. He has reduced his alcohol intake to 30 units/week and has lost 1/2 stone in weight.

  1. Would you diagnose and treat him for hypertension?
    • NICE says:
    • If clinic blood pressure is between 140/90 mmHg and 180/110 mmHg, offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension. See section 1.5 for people with a clinic blood
    • If BP 180/110 mmHg or higher, look for end-organ damage.  If present – treat.  If not present, repeat BP 1w later.   
    • Always look up the latest guidance on NICE.
  2. Would your practice follow him up in an in-house clinic?
    • Yes – hypertension clinic, preferably
  3. How might this clinic be organised?
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