Comprehensive review Mary has medical compliance as she is not taking her medicine on time. Mary is skipping her fluid tablet i.e Furosemide makes her urinate more frequent. Mary takes Perindopril(5mg) for her hypertension As it is suggested to take only 2.5 mg for people having renal impairment1. As Perindopril is not able to maintain her BP, so her GP should review if Perindopril is the best medication for her to use. As therapeutics guidelines suggest that Mary should combine 2 or more drugs for the management of her BP to reach the normal target2. Anyway, Mary should engage in physical activity. As, she used to go regularly for gym but she has completely stop going there. Her BMI is 28.9 on her weight 74 kg and height 165cm. For patients having diabetes, the healthy range of BMI is (18.5-24.9) and engage in more physical exercise3. Mary falls in overweight category. The non-pharmacological management should be adopted which includes weight reduction, sodium restriction, avoidance of alcohol intake, regular physical exercise, healthy eating and cessation of smoking. Mary should disregard eating take-away and start on a healthy diet and do more exercises4. As in Mary’s case Metformin and Perindopril is already in high dose which is dangerous for renal function. So her medication should be monitored. Problem List Actual Problem: Mary’s lab test shows that she has renal function is CrCl 40ml/minute. Due to frequent urge to go bathroom Mary’s stops taking her fluid tablet i.e. Furosemide in weekdays and takes only at weekends which increases her weight as a result of fluid retention in the body. Mary is currently overweight with a BMI 28.9 and has gained 5 kg in last 2 months. Mary is also diagnosed with Type 2 diabetes and is also hypertensive with a BP of 150/90. The factors that are contributing to his actual problem are negligence towards medication, alcohol consumption, her diet, decreased physical activity, interactions and side-effects of medicines. Potential Problems: Renal impairment increases risk of hyperkalaemia and may affect the excretion of some ACE inhibitors5. A potential risk of developing hyperkalaemia is cardiac arrhythmia and in severe case cardiac arrest. Mary has been taking too many take-away which contains high amount of salt which may lead to increase in blood pressure and high cholesterol increases risk of diabetes and heart diseases. Mary is at increased risk of having obesity. Excess body weight is common worldwide and is public health problem and an important cardiovascular risk for individuals and associated with many risk factors for CVD including type 2 diabetes, elevated blood pressure and dyslipidaemia, including osteoarthritis, poor mental health, some cancers, and conditions affecting reproductive and gastrointestinal systems6. 1.Mims Online https://www-mimsonline-comau.ezp01.library.qut.edu.au/Search/AbbrPI.aspx?ModuleName=Product%20Info&se archKeyword=Perindopril&PreviousPage=~/Search/QuickSearch.aspx&SearchType =&ID=76250001_2 2. eTG complete. [Internet]. Melbourne (VIC): Therapeutic Guidelines Ltd.; 2015. Elevated Blood Pressure: [cited 2017 Sep 28]; [6 screens]. Available from: https://tgldcdp-tg-orgau.ezp01.library.qut.edu.au/viewTopic?topicfile=elevated-blood-pressure#MPS_d1e1264 3. EveryDay Health https://www.everydayhealth.com/hs/type-2-diabetes-live-better-guide/does-bmi-matter/ 4. Malays Fam Physician 2011 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267017/ 5. AMH https://amhonline-amh-net-au.ezp01.library.qut.edu.au/chapters/cardiovasculardrugs/antihypertensives/ace-inhibitors/perindopril?menu=hints 6. ETG Complete https://tgldcdp-tg-org-au.ezp01.library.qut.edu.au/viewTopic?topicfile=cardiovascular-disease-riskmodification#toc_d1e91
