Most probable Diagnosis Evidence from monitoring Blood Pressure Measured using home monitoring device weekly 165 Peak reading 150 Average reading 130 Min reading Evidence from EMR Family history of Essential Hypertension Overweight Smokes 20 cigarettes a day Takes little exercise Evidence from Validated Knowledge Bases Essential Hypertension is the most common cause of raised Blood Pressure in population Evidence from Expert System Questioning None Suggested Management source: WHO standard care pathway for Essential Hypertension Lifestyle Advice Physician Check Advised to stop smoking not required Advised to lose weight not required Adviced to take more expercise not required Adviced to reduce salt intake not required Home Monitoring Changes Home Blood Pressure monitoring frequency changed from monthly to continuous ambulatory monitoring not required Gym/Well-being Centre Monitoring Requirements Blood screen to help rule out differential diagnoses not required Urinalysis to help rule out differential diagnoses not required ECG to rule out cardiovascular complications and risk not required Remote fundoscopy examination not required Drug Management None not required Follow-Up Repeat Expert System consultation after tests at Gym and 1 month ambulatory Blood Pressure monitoring completed. not required Expert System Patient Report [05th January 2016] 1
Complications and Risk Factors Stroke Home Monitoring Raised BP is a risk factor EMR No previous diagnosis of Stroke Transient Ischaemic Attack Home Monitoring Raised BP is a risk factor EMR No previous diagnosis of Transient Ischaemic Attack Heart Failure Home Monitoring Raised BP is a risk factor EMR No previous diagnosis of Heart Failure Myocardial Infarction Home Monitoring Raised BP is a risk factor EMR No previous diagnosis of Myocardial Infarction Angina Home Monitoring Raised BP is a risk factor EMR No previous diagnosis of Angina Peripheral Vascular Disease Home Monitoring Raised BP is a risk factor EMR No previous diagnosis of Peripheral Vascular Disease Fundal Hemorrhages Home Monitoring Raised BP is a risk factor EMR No previous diagnosis of Fundal Haemorrhages Papillodema Home Monitoring Raised BP is a risk factor EMR No previous diagnosis of Fundal Papillodema Expert System Patient Report [05th January 2016] 2
Chronic Renal Failure (1.50%) U+Es 4/12 ago Gym Urinalysis Test Result Date Place MSU 4/12 ago Gym Glomerulonephritis (0.50%) EMR No previous diagnosis of Glomerulonephritis U+Es 4/12 ago Gym LFTs 4/12 ago Gym CRP Not part of routine blood screen Immunoglobulin Not part of routine blood screen Complement C3, C4 Not part of routine blood screen Diabetic Nephropathy (0.50%) EMR No previous diagnosis of Diabetic Nephropathy Polycystic Disease (0.30%) EMR No previous diagnosis of Polycystic Disease Urinalysis Test Result Date Place Haematuria 4/12 ago Gym Expert System Q: Have you noticed any blood in your urine? Wilm s Tumor (0.30%) EMR No previous diagnosis of Wilm s Tumor Expert System Q: Have you noticed any blood in your urine? Knowledge Base Hypertension is rare complication of Wilm s Tumor Continued Expert System Patient Report [05th January 2016] 3
continued Cushing s Disease (0.10%) EMR No previous diagnosis of Cushing s Disease Conn s Syndrome (0.10%) EMR No previous diagnosis of Conn s Syndrome Expert System Q: Have you noticed that you are drinking more than usual? Q: Are you urinating more frequently than usual? Q: Have you noticed any muscle weakness recently? Phaechromocytoma (0.10%) EMR No previous diagnosis of Phaechromocytoma Acromegaly (0.10%) EMR No previous diagnosis of Acromegaly Diabetes Mellitus (0.05%) EMR No previous diagnosis of Diabetes Mellitus Expert System Q: Have you noticed that you are drinking more than usual? Q: Are you urinating more frequently than usual? Hyperparathyroidism (0.05%) EMR No previous diagnosis of Hyperparathyroidism Congenital Adrenal Hyperplasia (0.05%) EMR No previous diagnosis of Adrenal Hyperplasia Familial Hyperaldosteronism Type I (0.05%) EMR No previous diagnosis of Familial Hyperaldosteronism Type I Knowledge Base Rare condition Continued Expert System Patient Report [05th January 2016] 4
continued Hyperthyroidism (0.05%) EMR No previous diagnosis of Hyperthyroidism No weight loss Home Monitoring No tachycardia LFTs 4/12 ago Gym Thyroid function tests 4/12 ago Gym Apparent Mineralocorticoid Excess (0.05%) EMR No previous diagnosis of Apparent Mineralocorticoid Excess Pre-Eclampsia of pregnancy (0.05%) EMR Not female Drug-Induced Hypertension (0.05%) EMR No medication that has raised BP as a known side effect Coarction of the Aorta (0.05%) EMR No previous diagnosis of Coarction of the Aorta Polycythaemia Vera (0.05%) EMR No previous diagnosis of Polycythaemia Vera Expert System Patient Report [05th January 2016] 5