ABSTRACT
The case A 43-year-old premenopausal Afro-Caribbean lady with hypertension was referred by her family doctor. She had just registered with the practice and was taking lisinopril 15 mg daily but her blood pressure was poorly controlled at 160/110 mm Hg.The doctor added atenolol 100 mg daily and the pressure improved to 140/102 mm Hg. Her renal function was normal and the fasting cholesterol was 5.8 mmol/l, triglycerides 1.0, HDL-cholesterol 2.7, and LDL-cholesterol 2.6 mmol/l. Her hemoglobin was 15.6 g/dl and glucose 4.7 mmol/l. She was complaining of chest tightness ‘on and off’ for a year, which she was not unduly concerned about. A trial of glyceryl trinitrate sublingually had surprisingly been beneficial.When I saw her I noted that she was overweight with a body mass index (BMI) of 30 kg/m2 and had been smoking 10 cigarettes a day. Her resting ECG was normal. Her echocardiogram showed mild left ventricular hypertrophy and good left ventricular function.
