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John is a 56 year old accountant who presents enquiring about Viagra. 
Over the past year he has had increasing difficulty having an erection and a few times he has succeeded he has faded during intercourse. He now is worried about starting sexual activity due to embarrassment of failure.

 

He has let his health slip a little over previous years, with a gain of 10 Kg in weight. He now has a BMI of 30. This has led to worsening of his hypertension. 18 months ago he was changed from an A2 blocker to a combination medication at higher dose combined with hydrochlorothiazide.

 

This has normalised his blood pressure.

 

He has a family history of coronary heart disease with his father having an infarction aged 60, and a brother with angina at 59.