Mr Mark Davis is a 66 year old man whom you have been managing for almost twenty years . For most of that time you have found him to be hypertensive and despite your best efforts his BP control has been 'sub-optimal'.

His most recent BP has been 155/95mmHg despite being on two agents.

Mark has also been a smoker but you did convince him to stop about five years ago. He has also required a 'statin' for cholesterol in recent years.

Mark comes in requesting a 'thorough going over' as his brother has recently died from an AMI. You decide to check his renal function amongst his investigations and to your surprise his serum creatinine is 210 µmol/l (normal <120 µmol/l)

You have no record of a previous level.