Referral to Hypertension Clinic
Dear Dr. [Specialist's Last Name],
I hope this letter finds you in good health and high spirits. I am writing to seek your expert opinion and advice regarding a challenging case of hypertension that I have been managing at my general practice.
The patient in question, Mrs. A Smith, has been under my care for the past year for the management of her essential hypertension. Despite our diligent efforts and thorough evaluation, her blood pressure remains consistently elevated, failing to achieve the desired target range even with the use of first-line, second-line, and third-line antihypertensive medications.
To provide you with a brief understanding of the patient's medical history, Mrs. A. Smith, a 56-year-old female, was diagnosed with hypertension seven years ago. She does not have any significant comorbidities, such as diabetes or renal dysfunction. Lifestyle modifications, including dietary changes, regular exercise, and stress reduction techniques, have been actively encouraged and implemented throughout her treatment course.
Initially, she was started Mrs. Smith on a thiazide diuretic (hydrochlorothiazide) as a first-line agent, along with appropriate lifestyle changes. However, despite gradual titration and adherence to the treatment regimen, her blood pressure remained above the target level of <130/80 mmHg. Consequently, the treatment was escalated to include an angiotensin-converting enzyme inhibitor (lisinopril) as a second-line agent, in addition to the existing antihypertensive medication.
Recently, I introduced a calcium channel blocker (amlodipine) as a third-line agent, aiming to achieve better blood pressure control. Mrs. Smith has remained compliant with her medication and has been engaging in regular follow-ups to ensure appropriate monitoring.
However, despite our comprehensive treatment plan involving three different classes of antihypertensive medications, Mrs. Smith's blood pressure continues to exceed the recommended limits. This persistent uncontrolled hypertension is a matter of concern for both myself and Mrs. Smith, urging us to explore further therapeutic options.
Knowing your esteemed expertise in the field of hypertension management, I humbly request your guidance in evaluating this complex case. I am particularly interested in exploring alternative treatment strategies or potential additional lines of therapy that may help us optimize her blood pressure control.
I kindly request you to review Mrs. Smith's medical records and advise me on any additional diagnostic tests or specialist consultations that could deepen our understanding of her condition. Additionally, if you deem it appropriate, I would greatly appreciate your insights on any alternative medications or combination therapies that have shown proven efficacy in cases refractory to standard treatment approaches.
I assure you that my patient's best interests are at the forefront of my decision-making, and your thoughtful guidance would undoubtedly be of great value in improving her quality of life. Rest assured, I will communicate any recommendations or changes to the patient after considering your advice.
Thank you, in advance, for your time and consideration. I eagerly look forward to hearing from you and learning from your esteemed expertise.
Yours sincerely,
Shilpa Patel
Lead Prescribing Pharmacist
WellBN Surgery
I hope this letter finds you in good health and high spirits. I am writing to seek your expert opinion and advice regarding a challenging case of hypertension that I have been managing at my general practice.
The patient in question, Mrs. A Smith, has been under my care for the past year for the management of her essential hypertension. Despite our diligent efforts and thorough evaluation, her blood pressure remains consistently elevated, failing to achieve the desired target range even with the use of first-line, second-line, and third-line antihypertensive medications.
To provide you with a brief understanding of the patient's medical history, Mrs. A. Smith, a 56-year-old female, was diagnosed with hypertension seven years ago. She does not have any significant comorbidities, such as diabetes or renal dysfunction. Lifestyle modifications, including dietary changes, regular exercise, and stress reduction techniques, have been actively encouraged and implemented throughout her treatment course.
Initially, she was started Mrs. Smith on a thiazide diuretic (hydrochlorothiazide) as a first-line agent, along with appropriate lifestyle changes. However, despite gradual titration and adherence to the treatment regimen, her blood pressure remained above the target level of <130/80 mmHg. Consequently, the treatment was escalated to include an angiotensin-converting enzyme inhibitor (lisinopril) as a second-line agent, in addition to the existing antihypertensive medication.
Recently, I introduced a calcium channel blocker (amlodipine) as a third-line agent, aiming to achieve better blood pressure control. Mrs. Smith has remained compliant with her medication and has been engaging in regular follow-ups to ensure appropriate monitoring.
However, despite our comprehensive treatment plan involving three different classes of antihypertensive medications, Mrs. Smith's blood pressure continues to exceed the recommended limits. This persistent uncontrolled hypertension is a matter of concern for both myself and Mrs. Smith, urging us to explore further therapeutic options.
Knowing your esteemed expertise in the field of hypertension management, I humbly request your guidance in evaluating this complex case. I am particularly interested in exploring alternative treatment strategies or potential additional lines of therapy that may help us optimize her blood pressure control.
I kindly request you to review Mrs. Smith's medical records and advise me on any additional diagnostic tests or specialist consultations that could deepen our understanding of her condition. Additionally, if you deem it appropriate, I would greatly appreciate your insights on any alternative medications or combination therapies that have shown proven efficacy in cases refractory to standard treatment approaches.
I assure you that my patient's best interests are at the forefront of my decision-making, and your thoughtful guidance would undoubtedly be of great value in improving her quality of life. Rest assured, I will communicate any recommendations or changes to the patient after considering your advice.
Thank you, in advance, for your time and consideration. I eagerly look forward to hearing from you and learning from your esteemed expertise.
Yours sincerely,
Shilpa Patel
Lead Prescribing Pharmacist
WellBN Surgery
Shilpa Patel
Lead Presscribing Pharmacist and GP partner at WellBN
Creator of AskShilpa.com, I also write for the Chemist & Druggist and EmpowHER and am passionate about inspiring and encouraging pharmacists to explore new avenues and promoting excellence in the field. I have over 17 years of experience in community pharmacy and 8 years as a clinical pharmacist. Through my work, I have gained a deep understanding of general practice by creating and supervising a team of nine pharmacists and training them in their individual roles. I have also led on a GP merger and successfully run a benzodiazepine detox clinic. Additionally, I have been the medication lead for a primary care organization. Related Articles
