You have a patient with chronic hypertension. What indicates that the patient's BP is not under control?

In patients with chronic hypertension, elevated blood pressure can lead to damage in various organs, including the kidneys. Elevated creatinine levels indicate that the kidneys are not functioning properly, which can be a direct consequence of unresolved hypertension. Chronic high blood pressure can lead to conditions such as hypertensive nephropathy, where the filtering units of the kidneys become damaged, leading to impaired filtration and higher levels of creatinine in the blood. Therefore, when creatinine levels are elevated, it serves as a strong indicator that a patient's blood pressure management may not be adequate, reflecting that the hypertension is not under control and potentially causing renal impairment.

In contrast, a heart rate of 55 could be a normal finding in some individuals, especially athletes or those on beta-blockers; irregular heart sounds may signal arrhythmias but do not directly indicate blood pressure control; and a blood glucose level of 128 is elevated but would not specifically assess the control of hypertension. Each of these points underscores why elevated creatinine is the most direct indicator among the options provided.