A 69-year-old electrician with hypertension has been managed with medication for 19 years. He currently takes three tablets each morning and attends for a repeat prescription. He has heard that “his medicine” may no longer be available.
In 2002, he had been started on cilazapril at a dose of 0.5mg. This was gradually up-titrated to 5mg each morning. In 2010, he was changed to cilazapril 5mg with hydrochlorothiazide 12.5mg (Inhibace Plus). In 2015, amlodipine 2.5mg was added, along with atorvastatin 20mg daily to lower his overall cardiovascular risk.
He has also been encouraged to maintain the recognised lifestyle methods to lower his blood pressure: exercise more, lose weight, eat less salt, drink less alcohol and stop smoking (he has never smoked).
His blood pressure is 145/85mmHg. You arrange for an electrocardiogram and discuss the current situation.