Over the last few months I have come across a couple of cases during health surveillance, where the gentlemen I have seen have had high blood pressure but with the right guidance and direction, have sought medical attention and can continue their jobs fully.
The first study was a gentleman I saw initially in October 2019. He worked for a company which carried out installation work which took him all around the country, driving a company van. In addition to driving, he had to work at height and often worked alone. I was therefore asked to carry out a full safety-critical medical.
He was a 54-year-old male and lived alone. He wasn’t originally from the area he worked in and hadn’t seen or ever registered with a GP in his local area even though he had been resident there for approximately 20 years.
I went through the general questionnaire with him, he had a high BMI, he was a 20-30 a day smoker and drank 30 units of alcohol a week. On checking his blood pressure, I took 3 readings which averaged 238/145 and an average pulse of 90.
I alerted him to the fact that his blood pressure was at dangerous levels and advised him to see his GP immediately (this is when I established he didn’t have one). I then asked him he must either go to one of the walk-in centres in the area or go straight to A&E at the local hospital but stressed he must not drive there. It transpired that a colleague was a manager/family member so I sought permission to be able to speak to his relative and see if he could arrange some transport for him.
This was my last person of the day, so I didn’t hear anything until I was asked back to do a review on him approximately 4-6 weeks after.
He said he went straight to the walk-in centre where they took his blood pressure again and found it to be at the same level, so they arranged for him to go straight to the hospital. The hospital carried out a number of tests including x-rays and an ECG. They kept him in to monitor his blood pressure that day and was then started on a course of medication.
On his review, he informed me that he had cut down on the number of cigarettes he was smoking, reduced his alcohol intake and started to eat more healthily and started to lose a bit of weight. He also had a home monitor and was checking his blood pressure 3 times a day. The medication he had was to take 10mg in the morning and if after the evening reading it was still raised, he took an extra 5mg. On checking his blood pressure on his review, it was still a little raised but in line with being able to pass him for safety-critical work. He is also now registered with a GP and having regular check-ups.
Although he wasn’t particularly happy with me at the first assessment (for telling him he couldn’t work!), he did thank me on the review for picking up his high blood pressure and insisting he went and sought immediate medical attention. In no uncertain terms, he was advised by the hospital that he was “a ticking time bomb”. It will be interesting to see him again later in the year for his annual review.
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Another case I came across earlier this year was a gentleman who did work which involved ropes to access high buildings so a full safety-critical was carried out on him.
He was 50 years old and slightly overweight. He was an ex-smoker and declared he drank 21 units of alcohol a week (although a few of his colleagues I saw after him offered up information of him likely enjoying more than what he probably declared!)
After taking his blood pressure three times, the average was 170/108 and an average pulse of 48. He is under the GP for various issues which he takes medication for and he said he had seen the GP only 10 days before this safety-critical and his blood pressure was normal at that appointment.
After gaining permission I advised the health and safety officer that he should go and get it checked out with his GP. The health and safety officer also asked if I could take his blood pressure at the end of my clinic as he had been relaxing in the office for the rest of the afternoon and had made an appointment to see his GP the following day. On taking it at the end of the clinic it was 190/135. With blood pressure that high I don’t think he was feeling that relaxed but instead panicking a bit!
I am yet to review this gentleman, but I have spoken to the health and safety manager to get an update for my case study and he did see his GP and he is now being monitored. He hasn’t been prescribed any medication as yet but he has taken the path to cut down on alcohol and to eat more healthily.
The company have also purchased a blood pressure monitor to be used by all staff should they wish to use it. The health and safety manager is a former health care worker so he will provide training or take their blood pressures should they wish as a few of the staff I saw were on the pre high blood pressure spectrum and they are very keen to promote health and wellbeing.
29 January 2020
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