Adequate Compensation of a Hypertensive Patient According to Current ESC Guidelines – Case Study
A 65-year-old man, hypertensive, visits the general practitioner for a check-up. He reports recent shortness of breath during mild exertion (walking up stairs). Two months ago, he had acute sinusitis, for which he was prescribed antibiotics (penicillin V) by a specialist. He experiences hip pain and suffers from a runny nose in the spring (allergy?). He has been treated for hypertension for approximately 8 years.
Family History
His father died at the age of 73 from a heart attack, and his mother at 69 from lung cancer. She was also treated for high blood pressure for a long time. His brother (68 years) is also being treated for "high blood pressure and high cholesterol"; his younger sister (52 years) is healthy.
Personal History
The patient was a long-time pipe smoker (since the age of 20), but quit smoking 6 years ago. He retired recently and engages in sports (plays golf 1–2 times a week). He admits to consuming "a lot" of alcohol. He does not pay attention to the composition of his diet regarding fats or sugars ("I eat what I want"). He usually adds extra salt to his food. He has gained 6 kg over the last year.
He denies non-compliance with the recommended medication. He has never experienced chest pain or noticed blood in his sputum. He has mild shortness of breath when climbing stairs. He hasn't noticed blood in his stool. He reports increased nighttime urination over the last 6 months, otherwise without dysuric difficulties. He occasionally treats left knee pain with acetylsalicylic acid (Aspirin).
Current Medication
Combination of amiloride + chlortalidone (Amicloton) 1 tablet every other day. Uses ibuprofen (Brufen) for pain, and nasal drops (can't recall the name) for a blocked nose.
Objective Physical Findings
BP 150/98 mmHg (sitting), 155/110 mmHg (standing); heart rate 56/min, regular.
Body weight 89 kg, height 180 cm, BMI = 27.5 kg/m2.
Supportive and Laboratory Examinations
Total cholesterol 7.5 mmol/l, HDL-C 0.75 mmol/l, LDL-C 4.69 mmol/l, triglycerides 4.52 mmol/l, HbA1c 7.0 mg/dl, uric acid 600 µmol/l.
The patient was prescribed a fixed combination of sartan and CCB due to the presence of hyperuricemia, which could be further worsened by thiazide/thiazide-like diuretics. The chosen medication was a fixed combination of telmisartan (40 mg) and amlodipine (5 mg) Tezefort, with a dosage of 1 tablet daily. Additionally, antihyperuricemic treatment with allopurinol and antidiabetic treatment with metformin was initiated.
Follow-up in 1 Month
The patient reports adhering to the recommended diet and exercise regimen.
BP 140/95 mmHg (sitting), 145/100 mmHg (standing).
Body weight 85 kg, height 180 cm, BMI = 27.0 kg/m2.
Total cholesterol 6.48 mmol/l, HDL-C 0.91 mmol/l, LDL-C 3.49 mmol/l, triglycerides 4.29 mmol/l, HbA1c 6.5 mg/dl, uric acid 450 µmol/l.
The dose of telmisartan was increased to 80 mg while maintaining the same dose of amlodipine. At the next month's check-up, BP 130/80 mmHg (sitting), 135/85 mmHg (standing).
MUDr. Jiří Slíva, Ph.D.
Institute of Pharmacology, 3rd Faculty of Medicine, Charles University, Prague
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Paediatric cardiology Internal medicine Cardiology General practitioner for adults
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