Category: HEARTe

Evelyn collects her prescription

Evelyn’s GP is happy with her progress – her blood pressure is below the target level of 140/90 mmHg, her ankle swelling has resolved and her U&Es remain within the normal range.

Evelyn has been put on a repeat prescription for:

  • Amlodipine 5mg once a day
  • Ramipril 10mg once a day

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Choosing a Calcium Channel Blocker (CCB) for Evelyn

First choice of antihypertensive for Evelyn is a calcium channel blocker (CCB) although a thiazide diuretic could be used at this stage if she was intolerant of the CCB, she had oedema, or was at risk of heart failure.

But which CCB should she be prescribed?

The decision to use either a rate-limiting or a dihydropyridine calcium-channel blocker will depend on the person’s co-morbidities and other drugs the person is taking.

Evelyn's calcium channel blocker table

NEXT STEP: Evelyn is prescribed amlodipine 5mg, once a day, and advised to come back in 4 weeks to see how she is getting on

Initial choice of antihypertensive for Evelyn

Evelyn now understands the importance of starting antihypertensive medication. Which class of anti-hypertensive should be prescribed for her at this stage?

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What are the effects of untreated hypertension?

Untreated hypertension can impact on and damage the entire circulatory system:

  • The force exerted by high blood pressure causes microscopic tears in the walls of blood vessels. These turn into scar tissue.
  • The damaged areas and scar tissue in the blood vessel walls accumulate materials circulating in blood, such as, cholesterol, platelets and fats. This leads to a build-up of plaque on blood vessel walls, causing them to narrow.
  • Hypertension speeds up hardening of the arteries, making the blood vessel walls less flexible

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Ambulatory blood pressure monitoring (ABPM)

When Evelyn visits her GP practice for her annual review, her clinic blood pressure is 164/105 mmHg. Evelyn is referred to the practice nurse for 24 hour ABPM.

Evelyn sees the practice nurse and is fitted with an ambulatory blood pressure cuff. She is advised to wear the device for 24 hours. Her BP is measured regularly via the cuff and a device that is worn on her waist. A follow-up appointment is made. 

Lifestyle factors and blood pressure

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(Ref: Chobanian AV et al., JAMA 2003; 289: 2560-2572 Blumenthal JA et al., Arch Intern Med 2000; 160: 1947-1958.)

Evelyn’s review appointment

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Evelyn has all tests done, as per guideline, including referral for 24hr ABPM/HBPM. What else would happen as part of Evelyn’s annual review?

  • Bloods: U&Es, cholesterol
  • FBC, LFTs, glucose
  • BMI
  • Urine test
  • Advice regarding:
    • Eye tests
    • Exercise
    • Diet
    • Alcohol consumption
    • Weight management