Pete and Mihir. Why they’re important Which risk factors? Risk assessment.
-
Upload
reynold-conley -
Category
Documents
-
view
217 -
download
0
Transcript of Pete and Mihir. Why they’re important Which risk factors? Risk assessment.
![Page 1: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/1.jpg)
Pete and Mihir
![Page 2: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/2.jpg)
Why they’re important Which risk factors? Risk assessment
![Page 3: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/3.jpg)
Curriculum statements◦ 5 Healthy people, promoting health and
preventing disease◦ 15.1 Cardiovascular problems
![Page 4: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/4.jpg)
QOF - In those patients with a new diagnosis of hypertension (excluding those with pre-existing CHD, diabetes, stroke and/or TIA) recorded between the preceding 1 April to 31 March: the percentage of patients aged 30 to 74 years who have had a face-to-face cardiovascular risk assessment at the outset of diagnosis (within 3 months of the initial diagnosis) using an agreed risk assessment tool
8 Points Disease Prevalence
![Page 5: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/5.jpg)
That warm fuzzy feeling that comes in the knowledge you are saving people’s lives (by reducing 10 year cardiovascular end point incidence)
![Page 6: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/6.jpg)
45,000
![Page 7: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/7.jpg)
Lifestyle factors you can change Factors you can’t change Factors that can be treated
![Page 8: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/8.jpg)
Family History
![Page 9: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/9.jpg)
Male
![Page 10: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/10.jpg)
Age
![Page 11: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/11.jpg)
Extreme baldness
![Page 12: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/12.jpg)
Early menopause
![Page 13: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/13.jpg)
Age
![Page 14: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/14.jpg)
Ethnic group
![Page 15: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/15.jpg)
Smoking
![Page 16: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/16.jpg)
Sedentary lifestyle
![Page 17: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/17.jpg)
Obesity
![Page 18: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/18.jpg)
Salt/diet
![Page 19: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/19.jpg)
Alcohol
![Page 20: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/20.jpg)
Hypertension
![Page 21: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/21.jpg)
Cholesterol
![Page 22: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/22.jpg)
triglycerides
![Page 23: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/23.jpg)
diabetes
![Page 24: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/24.jpg)
Chronic kidney disease
![Page 25: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/25.jpg)
Anyone age 40-74 who is likely to be at high risk – calculate risk with data already available (NICE)
Anyone over 40 (JBS2)
![Page 26: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/26.jpg)
The following patients should not have their risk calculated, as they are considered already to be at high enough risk to justify lifestyle and other interventions◦ Patients with atherosclerotic CVD.◦ Hypertension (≥160/100 mm Hg) with target organ
damage.◦ Patients with type 1 or type 2 diabetes mellitus.◦ Renal dysfunction (including diabetic nephropathy).◦ Familial hypercholesterolaemia, familial combined
hyperlipidaemia ◦ People aged 75 or older should also be considered at
increased risk of CVD, particularly if hypertensive or smokers.
![Page 27: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/27.jpg)
Use a validated tool to calculate estimated 10 year risk.
Discuss lifestyle modification Start/change treatment
![Page 28: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/28.jpg)
Framingham with JBS2 adjustments QRisk2
Type 2 diabetes (early on)◦ UKPDS
![Page 29: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/29.jpg)
![Page 30: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/30.jpg)
![Page 31: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/31.jpg)
Tends to overestimate UK population risk
Underestimates risk of socially deprived/south asian/female populations
Age (30-74) Smoking Status Sex Glucose LVH
BP Central Obesity Total Cholesterol South Asian Origin HDL Cholesterol Family History of
CVD(Men <55 and women <65 years)
Total /HDL Ratio Serum TG mmol/L
![Page 32: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/32.jpg)
![Page 33: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/33.jpg)
Patient age (30-84). Patient gender. Current smoker
(yes/no). Diabetic. Family history of
heart disease aged <60 (yes/no).
Treatment with blood pressure agent .
Postcode (Townsend score)
Body mass index (height and weight).
Systolic blood pressure (use current not pre-treatment value).
Total and HDL cholesterol.
Ethnicity. Rheumatoid arthritis. Chronic kidney
disease. Atrial fibrillation.
![Page 34: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/34.jpg)
http://www.patient.co.uk/doctor/Primary-Cardiovascular-Risk-Calculator.htm
www.qrisk.org
www.dtu.ox.ac.uk
![Page 35: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/35.jpg)
![Page 36: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/36.jpg)
![Page 37: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/37.jpg)
Is it a disease? Is it an illness?Is it a condition?Is it a syndrome?What is it?
![Page 38: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/38.jpg)
Hypertension is the one of the most important preventable causes of morbidity and mortality in the UKIt is a major risk factor for cardiovascular diseaseAt least one quarter of adults (and more than half of those are above 60) in the UK have high blood pressure2mmHg rise in systolic BP causes 7% increased risk of mortality in IHD and 10% increased risk of mortality from strokeThe NHS spent £1 billion on drug costs alone on blood pressure management in 2006
![Page 39: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/39.jpg)
140/90?135/85?
160/100?180/110???
![Page 40: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/40.jpg)
Stage 1 Hypertension:Clinic blood pressure is 140/90mmHg or higher and subsequent ABPM daytime average or HBPM average blood pressure of135/85mmHg or higherStage 2 Hypertension:Clinic blood pressure is 160/100mmHg or higher and subsequent ABPM daytime average or HBPM average blood pressure of 150/95mmHg or higherSevere Hypertension:Clinic systolic BP is 180mmHg or higher, or clinic diastolic BP is 110mmHg or higher
![Page 41: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/41.jpg)
Adequate initial training and periodic reviewAutomated devices regularly recalibrated. Do not use automated devices if there is pulse irregularityStandardize environment. Patient should be quiet and seated, with an outstretched and supported armFor postural hypotension patient should be stood for at least 1 minute before BP measurement (If SBP falls by ≥20mmHg – Review medication/Specialist referral)
![Page 42: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/42.jpg)
If clinic BP is ≥140/90, offer ABPM to confirm diagnosis of HTN
Clinic BP
Measure BP in both arms (Use arm with higher reading), if BP ≥140/90mmHg repeat BP. If substantially different repeat a third time.
Record the lower of the last 2 measurements as clinic BP
ABPM
At least 2 measurements per hour during waking hours
Use the average value of at least 14 measurements taken during usual waking hours
HBPM
For each BP reading, two consecutive measurements are taken, at least 1 minute apart and with the person seated
Record twice daily, ideally morning and evening
Record for at least 4 days, ideally 7 days (Discard first day’s readings)
![Page 43: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/43.jpg)
Use formal calculatorTest for proteinuria and haematuriaEstimation of the albumin:creatinine ratioBloods for plasma glucose, U&E, eGFR and lipidsFundus examination12 lead ECG
![Page 44: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/44.jpg)
![Page 45: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/45.jpg)
Lifestyle – Who? When? How?
Medication – Who? When? How? What?
Refer – Who? Where? When?
![Page 46: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/46.jpg)
Lifestyle advice should be offered initially then periodicallyDiet patterns:Five a dayBulk of most meals should be starch basedNot much fatty foods – Use low-fat, mono- or poly-unsaturated fatsInclude 2-3 portions of fish per week, at least one should be oilyLimit salt to 6g/day – Current UK average is 9g (Na content X 2.5 = Salt Content)If you ‘have’ to fry, choose a vegetable oil
![Page 47: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/47.jpg)
Exercise patterns:30 minutes in a day is probably minimum to gain health benefitsModerate physical activity means you get warm, mildly out of breath and mildly sweatyOn most days – You cannot ‘store up’ the benefits of physical activity
Alcohol:Men 21 units/week – No more than 4 units/dayWomen 14 units/week – No more than 3 units/day
![Page 48: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/48.jpg)
Relaxation therapiesExcessive consumption of caffeinated productsDo not offer magnesium, calcium and potassium supplementsStop smokingLocal initiatives
![Page 49: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/49.jpg)
Aged under55 years
Aged over 55 years/ black
person of African/Caribbean
family origin of any age
Step 1 A C
A + C
A + C + D
Resistant hypertensionA + C + D + consider further
diuretic or alpha- or beta-blocker
Consider seeking expert advice
Step 2
Step 3
Step 4
Choose a low-cost ARB.A CCB is preferred but consider a thiazide-like diuretic if a CCB is not tolerated or the person has oedema, evidence of heart failure or a high risk of heart failure.Consider a low dose of spironolactone or higher doses of a thiazide-like diuretic.At the time of publication (August 2011), spironolactone did not have a UK marketing authorisation for this indication. Informed consent should be obtained and documented.Consider an alpha- or beta-blocker if further diuretic therapy is not tolerated, or is contraindicated or ineffective.
![Page 50: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/50.jpg)
Offer step 1 treatment to people under 80 with stage 1 hypertension and one or more of:Target organ damageEstablished cardiovascular diseaseDiabetesRenal disease10 year cardiovascular risk higher than 20%
Offer step 1 treatment to people at any age with stage 2 hypertensionACEi (Low cost ARB) for people under 55 yearsCCB for over 55 years/Afro-Caribbean origin – If unsuitable/intolerant to CCB then start with thiazide like diuretic (Indapamide/Chlortalidone)Use beta-blockers in younger patients only if ACEi/ARBs are contraindicated, or there is evidence of increased sympathetic drive, and for women with child-bearing potential
![Page 51: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/51.jpg)
Offer CCB in combo with ACEi/ARBThiazide like diuretic if CCB unsuitableIf beta-blocker was used in step 1 add CCB rather than thiazide like diureticOptimise doses
![Page 52: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/52.jpg)
Offer ACEi/ARB in combo with a CCB and thiazide-like diuretic
If clinic BP ≥140/90mmHg regard as resistant hypertension
![Page 53: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/53.jpg)
Consider low dose (25mg) spironolactone if serum potassium level ≤ 4.5mmol/L – Monitor renal functionIf serum potassium level ≥ 4.5mmol consider higher dose of thiazide like diureticIf further diuretic therapy is contraindicated/ineffective, consider alpha- or beta-blockersIf BP remains uncontrolled maximum tolerated doses, seek expert advice
![Page 54: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/54.jpg)
Under 80s:Clinic BP – 140/90mmHgABPM/HBPM – 135/95mmHgOver 80s:Clinic BP – 150/90mmHgABPM/HBPM – 145/95mmHg
![Page 55: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/55.jpg)
![Page 56: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/56.jpg)
A few key points Optimise everything else before giving a
statin Add TFTs to hypertension/CV risk
assessment bloods if dyslipidaemia present Offer a statin to those with a 20% or
greater 10 year risk of CVD
![Page 57: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/57.jpg)
A few key points Support, advice, “stop date” “blips vs
“failure” Intensive support service Pharmacotherapy NRT vs NNRT (varenicline, bupropion –
MHRA warning) 1 go every 6 months How much to prescribe
![Page 58: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/58.jpg)
Patches 5, 10, 15 mg/16 hr (Nicorette®); 7, 14, 21 mg/24 hr (NiQuitin®)
Gum (2 mg, 4 mg) Nasal spray (0.5 mg per puff) Inhalation cartridge (10 mg cartridge plus
mouthpiece) Lozenges (1 mg, 2 mg, 4 mg) Sublingual tablets (2 mg)
![Page 59: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/59.jpg)
Decide on a quit date - the date you intend to stop smoking.
Start taking the tablets one week before the quit date. Start on 0.5 mg daily for three days. Then 0.5 mg twice daily on days four to seven. Then, 1 mg twice daily for 11 weeks.
Take each dose with a full glass of water, preferably after eating.
![Page 60: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/60.jpg)
One tablet (150 mg) each day for six days. Then increase to one tablet twice a day
Aim to stop smoking completely on day eight of treatment.
Continue the tablets for a further seven weeks
![Page 61: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/61.jpg)
![Page 62: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/62.jpg)
A, 48 year old male Clinic reading 142/92 Home readings 136/86 CV risk 6%
![Page 63: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/63.jpg)
B, 52 year old white female Home readings 136/86 LVH
![Page 64: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/64.jpg)
C, 48 year old white male, Clinic reading 162/106 ABPM 136/86 CV risk 25%
![Page 65: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/65.jpg)
D, 48 year old black male, Clinic reading 162/106 ABPM 136/86 CV risk 25 %
![Page 66: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/66.jpg)
E 50 year old black male Home readings 155/98 On amlodipine
![Page 67: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/67.jpg)
F, 65 year old Asian female Home readings 152/96 On ramipril and felodipine
![Page 68: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/68.jpg)
G, 55 year old black female New patient taking diclofenac for knees for
the last year. Feels well BP 184/114 ECG LVH + blood on urine dip Fundoscopy normal/abnormal
![Page 69: Pete and Mihir. Why they’re important Which risk factors? Risk assessment.](https://reader035.fdocuments.us/reader035/viewer/2022062321/56649d9e5503460f94a88da5/html5/thumbnails/69.jpg)