Post on 16-Jan-2016
NICE Guideline Synopsis
Definitions
Stage 1 HypertensionClinic BP 140/90 or higher And ABPM Daytime average/HBPM 135/85 or
higher
Definitions
Stage 2 HypertensionClinic BP 160/100 or higherAnd ABPM Daytime average/HBPM 150/95 or
higher
Definitions
Severe HypertensionClinic BP 180 systolic or higher or diastolic
110 or higher
DiagnosisIf clinic BP >140/90 then offer ABPM
ABPM should have at least 2 readings per hr in persons normal waking hours (usually 8-22.00)
Average of at least 14 readings required
Offer HBPM if ABPM is deemed unacceptable
BP should be taken in both arms-if difference >20mmHg use highest reading arm for subsequent reading
HBPMBP taken BD for minimum of 4 days but
ideally 7 days
Ideally morning and evening
2 BP readings done each time with patient seated and 1 minute apart
Discard readings done on day 1 and average remaining readings
TreatmentStage 1 Hypertension (=/>140/90 or 135/85)
<80Target organ damage (urine dip, ecg, fundi,
U&E, chol, BG)Renal diseaseCVDDiabetes10y CVD risk of 20% or higher
Stage 2 Hypertension (=/> 160/100 or 150/95)Any age
Severe HypertensionConsider starting medication same day
Specialist IxIf secondary causes suspectedSame day referral if concerns re accelerated
htn- BP >180/110 with papilloedema/retinal haemorrhage or suspected phaeochromocytoma (headache, labile/postural hypotension, pallor, palpitations and diaphoresis)
Young People<40 with Stage 1 Hypertension but no signs
of end organ damage/CVD/renal disease/diabetes consider specialist referral for further investigation of secondary causes as 10y CVD risk assessment underestimates risk in these people
Treatments<55y >55y or black Afro
Carribean1. ACEi/ARB2. CCB3. Thiazide like diuretic4. Low dose spironolactone
(25mg bd)if K<4.5. If K >4.5 consider higher dose thiazide diuretic
5. B blocker may be considered alternative to ACEi in young people/women of childbearing age
1. CCB (Thiazide like diuretic if heart failure/risk of/oedema/intolerance)
2. ACEi (ARB for black afrocaribean)
3. Thiazide like diuretic4. Low dose
spironolactone (25mg bd)if K<4.5. If K >4.5 consider higher dose thiazide diuretic
If treatment with a thiazide like diuretic is started or changed then use indapamide (1.25mg MR od or 2.5mg od) or chlortalidone (12.5-25mg od)
What About Lifestyle Advice?
Smoking/alcoholExerciseKeeping salt lowDiscourage excess caffeineRelaxation techniques if pt interestedAdvice re local initiatives for lifestyle help
TargetsClinic Readings ABPM/HBPM
<80 y<140/90
>80y<150/90
<80 y<135/85
>80y<145/85