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S.M. is a 61year man who goes to his general practitioner for evaluation and follow up of his medical problems. He has been treated for hypertension for 8 years. He reports a recent increase in shortness of breath with moderate exertion and bothersome nocturia. However, he states that he feels better today and just needs a check-up.

Family history:
Father died of acute myocardial infarction at age 73, mother deceased due to lung cancer at age 69 and "had high blood pressure". Brother (age 68) undergoes treatment for hypertension and "high cholesterol", younger sister (age 52) has no medical problems.

Patient´s history:
He had been smoking a pipe since his 20-ies and quit smoking about 6 years ago. He has recently retired and devotes time to gardening or climbing regularly every day. He pays attention to sodium, fat, or carbohydrate content of food ("I try to avoid it"). He usually uses ("a little") table salt for his foods. He denies "high consumption" of alcohol, and noncompliance with his medication. He experienced no chest pain, subjective or objective complaints at rest, or hemoptysis, only mild shortness of breath when climbing stairs.

Medication:
AMICLOTON (hydrochlorothiazide + chlorthalidon 2,5/25 mg 1 tabl/each two days orally for 8 years.

Patient examination:
BP: 150/98 mmHg (sitting), 155/110 mmHg (upright), heart rate: 56/min (regular), Body temperature = 36.8^o C. Body weight = 75 kg, height = 1,65 m. BMI = 27.5 (body mass index) - obesity. Neck: without bruits above vessels, supple without masses of bruits, n o thyroid enlargement or lymphadenopathy.
Lungs: A few basilar crackles, no wheezing.
Heart and abdomen normal.
Prostate slightly enlarged without nodules, induration, or asymmetry.
Extremities: no clubbing, cyanosis or edema.

Laboratories (fasting).
Blood: Na = 138 mEq/L, K= 4.1 mEq/L,
Cl = 103 mEq/L,
Serum creatinine = 105 µmol/l, glucose = 4.8 mmol/L, AST = 0.4 µkat/L, ALT = 0.5 µkat/L, ALP 2.0 µkat/L, total bilir. = 18 µmol/L, total prot. = 6.7 g/L,
Ca = 2.4 mmol/L, Mg = 0.9 mmol/L, phosp. 1.1 mmol/L, uric acid = 400 µmol/L.
 
Lipid profile: Total cholesterol: 7.7 mmol/L, HDL = 0.70 mmol/L, LDL= 4.8 mmol/L, triglycerides: 4.7 mmol/L.
 
Urine: color clear, pH = 5, protein (-), erythrocytes 0, white blood cells 0, bacteria 0
ECG: bradycardia, regular rhythm
Echocardiogram: sinusoidal rhythm, the axis shifted to the left, within normal conditions.
Ophthalmoscop. examination.Ocular fundus: mild changes of the arteriols, no papilledema, congestion of hemorrhage of the retina