The patient (click for patient details) came for a routine appointment during which his clinic blood pressure was measured as 149/96 mmHg. A blood pressure of over 140/90 mmHg might indicate that the patient had hypertension.

The patient therefore completed Ambulatory Blood Pressure Monitoring. The results of ABPM showed the patient's daytime average blood pressure to be 144/92 mmHg.

The clinic blood pressure of 149/96 mmHg plus the ABPM daytime average blood pressure of 144/92 mmHg resulted in the patient being diagnosed with stage 1 hypertension.

Physical examination of the patient and the results of the patient's various tests (blood, urine, electrocardiograph etc) indicated that there was no target organ damage, cardiovascular disease, renal disease or liver disease. The patient was not diabetic.

The patient's 10 year cardiovascular disease risk was calculated as 15.2%.

Because the patient's 10 year cardiovascular disease risk was ≥ 10%, he was advised to start pharmacological treatment for his stage 1 hypertension; he was also given advice on lifestyle modifications (which all patients with hypertension receive).

The patient had a BMI of 29.1, was a heavy smoker, had an unhealthy diet, drank more than the recommended weekly amount of alcohol and did not do sufficient physical exercise. The patient was given advice about how to improve his lifestyle including, for example, adopting a healthier diet, stopping smoking, reducing his alcohol intake and increasing his amount of physical activity. The recommendations given in NICE Guideline 136 were followed in order to choose the appropriate pharmacological treatment for the patient. The patient was a white, male aged 49 years.

For step 1 of treatment, the patient was started on an ACE inhibitor. The patient had no indications which would have made this treatment unsuitable.

On an ACE inhibitor alone, the patient's clinic blood pressure decreased to 145/93 mmHg. This did not meet the target blood pressure of less than 140/90 mmHg meaning that the patient's blood pressure was not yet adequately controlled. The patient was adhering to his drug regimen. The patient therefore moved to step 2 of treatment.

For step 2 of treatment, the patient started taking a calcium channel blocker in addition to the ACE inhibitor. The patient had no indications which would have made this treatment unsuitable.

On a combination of ACE inhibitor and calcium channel blocker, the patient's clinic blood pressure decreased to 137/88 mmHg. This was below the target blood pressure and the patient's blood pressure was adequately controlled.

The patient was then to be provided with an annual review of care.