THE HONG KONG MEDICAL ASSOCIATION
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July 2005 二零零五年七月
Questions Raised by My Patient with Hypertension
Dr. Kan Chi Leung, David Family Physician M.B.,B.S.(H.K.), M.R.C.P. (Ire), M.R.C.P.(UK), F.H.K.G.P., F.R.A.G.P., D.C.H. (RCSI), D.C.H. (NUI), D.C.H. (Glasg.), Dip. Derm. (Glasg.).
but a social beer drinker, consuming about two cans of beers during Sunday dinners. Physical findings were otherwise unremarkable. Cardiovascular and fundoscopic examinations were normal. Blood pressure taken on both arms were 165/100 mmHg, erect and supine and rechecked at 5 minutes intervals. Mr. Chan was not obese, with a body mass index of 23.0. Mr. Chan was explained about the nature of elevated blood pressure with the need for regular monitoring. He was given emphasis on lifestyle modifications; namely, a low salt, low fat diet; a sensible alcohol intake, adequate exercise and to keep his present body weight stable. The blood pressure of Mr. Chan persisted within the range 160-170/95-105 mmHg during his subsequent visits. Simple hypertension workup showed normal results that include normal renal function tests. Cholesterol (at 3.3 mmol/L) and triglycerides (1.4 mmol/L) levels both (normal). The fasting blood glucose, serum electrolytes and urinanalysis were also normal. Electrocardiogram showed normal sinus rhythm, with no evidence of left ventricular hypertrophy or myocardial ischemia. Chest x-ray did not revealed cardiomegaly. Even though there was no evidence of end-organ damage, the persistent high blood pressure greater than160/95 mmHg despite being put upon strict lifestyle modifications warranted antihypertensive treatments to bring the blood pressure to the normal acceptable levels. Mr. Chan turned up one week later and showed me his daily blood pressure diary measured at home by an automated measuring device borrowed from his friend. The home blood pressure monitoring ranged from 150160/90-95 mmHg. Mr. Chan expressed interests in exploring more information about 'hypertension'.

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