Management of Afro-Caribbean 58-year-old male with high blood pressure.

Investigation Approach:

• Measure blood pressure in both arms initially; if a difference greater than 15 mmHg persists, use the arm with the higher reading for subsequent measurements.
• Confirm hypertension diagnosis with ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) if clinic readings are between 140/90 mmHg and 180/120 mmHg.
• Conduct baseline investigations including urine albumin:creatinine ratio and haematuria testing, blood tests for HbA1c, electrolytes, creatinine, eGFR, total and HDL cholesterol, fundoscopic examination for hypertensive retinopathy, and a 12-lead ECG.
• Assess cardiovascular risk formally using an appropriate risk assessment tool.

Management Approach:

• Offer lifestyle advice focusing on healthy diet, regular exercise, reduced alcohol intake, smoking cessation, and salt reduction, tailored to the patient's context.
• Avoid potassium-containing salt substitutes due to potential risks in patients on ACE inhibitors or ARBs.
• Initiate antihypertensive drug treatment considering the patient's ethnicity; for Afro-Caribbean patients, calcium channel blockers are often first-line therapy.
• Monitor blood pressure regularly and adjust treatment to achieve target blood pressure levels.
• Consider specialist referral if postural hypotension symptoms persist or if secondary causes of hypertension are suspected.