Hypertension Review Note

Consult Summary

58yo M presents for routine HTN review. Uncontrolled on cilazapril 2.5 mg PO OD, home BP avg 148/92 mmHg. Clinic BP 152/94 mmHg. Asymptomatic, good adherence. Plan to uptitrate cilazapril to 5 mg PO OD, repeat U&Es in 2/52, lifestyle modifications discussed, and RV in 4/52.

Subjective

Presents for 6-monthly HTN review. Home BP readings over past 2 weeks averaging 148/92 mmHg. Reports 100% adherence to morning cilazapril with nil SEs (specifically denies dry cough or postural dizziness).

Dyslipidaemia, impaired glucose tolerance, gout.

Cilazapril (Zapril®) 2.5 mg PO OD (started 6 months ago, no recent changes), atorvastatin (Lipitor®) 20 mg PO ON, allopurinol 150 mg PO OD.

Ex-smoker (quit 2015). ETOH 10-12 std drinks/week (mostly beer on weekends). Diet high in processed foods and takeaway meals 3x/week. Walks dog 20 mins 3x/week. Moderate work stress as an accountant.

Penicillin (maculopapular rash).

Review of Systems

Nil CP, SOB, PND, DOE, orthopnea, ankle oedema, or palpitations.

Nil dizziness, headaches, syncope, or visual changes.

Nil polyuria, nocturia, or peripheral oedema.

ROS unremarkable with nil CP, SOB, DOE, PND, orthopnea, palpitations, dizziness, headaches, visual changes, nocturia, or oedema.

Objective

BP: 152 / 94 mmHg

HR: 76 bpm

BMI: 29.4 (Weight: 92 kg, Height: 1.77 m)

Recent Labs

Lipids: Total cholesterol 4.8 mmol/L, LDL 2.6 mmol/L, HDL 1.2 mmol/L, Triglycerides 2.2 mmol/L

HbA1c: 5.9 %

Renal Function: eGFR 78 mL/min, Creatinine 88 µmol/L

Assessment & Plan

Hypertension: Uncontrolled

Lab form given for repeat renal function (U&Es, creatinine, eGFR) in 2 weeks following ACEi dose increase. Continue home BP monitoring twice daily for 1 week prior to next visit.

Increase cilazapril (Zapril®) from 2.5 mg PO OD to 5 mg PO OD. Continue atorvastatin 20 mg PO ON and allopurinol 150 mg PO OD.

Advised to reduce dietary sodium intake, limit takeaway meals, reduce ETOH to < 10 std drinks/week with at least 2 alcohol-free days, and increase brisk walking to 30 mins 5x/week.

Referred to Green Prescription (GRx) for supported physical activity and nutritional guidance.

GP review in 4 weeks with home BP diary to assess response to dose titration.

\bp 152/94

\Wt 92

\Ht 177