Assessment of cardiovascular risk in primary care

A 41 year old white man presented to his general practitioner for a routine blood pressure check. He was asymptomatic and had an initial reading of 154/115 mm Hg. Subsequent ambulatory blood pressure monitoring (ABPM) showed that the average daytime reading was 137/89 mm Hg.

On further assessment he had no evidence of left ventricular hypertrophy on electrocardiography, and no silver wiring or other abnormalities were found on funduscopy. Laboratory tests showed total cholesterol 6.8 mmol/L (reference range <5 mmol/L), triglycerides 5.9 mmol/L (0.45-1.69), high density lipoprotein (HDL)-cholesterol 0.76 mmol/L (>1). There was no evidence of urinary microalbuminuria.

He drank a moderate amount of alcohol at weekends only and smoked 10 cigarettes a day. He had a medical history of depression and dyspepsia for which he took sertraline and omeprazole daily. He had no family history of cardiovascular disease (CVD).

His QRISK2 score was calculated as 10.3%. He was worried about what this meant for his health and wanted help in making decisions about how to proceed.