Finding calmer waters

Mary, a 74-year-old woman, was referred by her GP for management of longstanding labile hypertension.

She also reports peripheral oedema, treated with frusemide and Slow-K (potassium chloride). Her only other medications are sertraline 50mg daily for mild depression and cholecalciferol 1000µg daily for vitamin D deficiency.

Mary denies symptoms that would suggest a secondary cause of hypertension such as headache, palpitations, facial flushing or diaphoresis.

She has no features to suggest underlying obstructive sleep apnoea. She ingests no nasal decongestants, NSAIDs or COX-2 inhibitors.

Mary adds no salt to her food and is active, ocean swimming 500m, five days per week.

Mary’s BMI is 19.7kg/m2. Her initial blood pressure in her right arm is 164/76mmHg (with a subsequent reading of 174/80mmHg) and in her left arm, 170/84mmHg.

Cardiovascular examination is unremarkable. In