When the patient (click for patient details) had her blood pressure measured at the local pharmacy, her blood pressure reading was high. She made an appointment at the clinic. At the appointment, her clinic blood pressure was measured as 156/97 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 148/93 mmHg.

The clinic blood pressure of 156/97 mmHg plus the ABPM daytime average blood pressure of 148/93 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 renal disease or liver disease and the patient was not diabetic. However, there were signs of target organ damage in the form of left ventricular hypertrophy.

The patient's 10 year cardiovascular disease risk was calculated as 8.2%.

Because the patient had target organ damage in the form of left ventricular hypertrophy, she was advised to start pharmacological treatment for her stage 1 hypertension; she was also given advice on lifestyle modifications (which all patients with hypertension receive).

The patient had a BMI of 34.2, did not have a very healthy diet and did not do sufficient physical exercise. The patient was given advice about how to improve her lifestyle including, for example, adopting a healthier diet and increasing her 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 female, of Black African family origin, aged 53 years, in menopause.

For step 1 of treatment, the patient was started on a calcium channel blocker. The patient had no indications which would have made this unsuitable.

On a calcium channel blocker alone, the patient's clinic blood pressure decreased to 146/92 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 her drug regimen. The patient therefore moved to step 2 of treatment.

For step 2 of treatment, the patient started taking an angiotensin II receptor blocker in addition to the calcium channel blocker.

On a combination of calcium channel blocker and angiotensin II receptor blocker, the patient's clinic blood pressure decreased to 136/87 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.