NICE GUIDELINESHYPERTENSION

Masroor Syed

Latest Issue June 2006 Evidence Based http://www.nice.org.uk/nicemedia/pdf/cg034q

uickrefguide.pdf Important to be aware of this topic for both

AKT and CSA as it is bound to come up

Causes of Hypertension

Essential Renal Endocrine Pregnancy Miscellaneous including drugs

Hypertension complications

Stroke IHD LVH and heart failure End organ damage

Measuring Blood Pressure

Hypertension according to nice is a BP of greater than 140/90 (QOF > 150/90)

Need at least two further readings of > 140/90 in order to diagnose hypertension

Take these measurements one month apart or earlier if severe hypertension

In diabetics hypertension BP> 130/80

Threshold for offering drug treatment

BP > 140/90 if CVD risk of greater than 20% over 10 years use Framingham graphs

BP> 140/90 and existing CVD or target organ damage

Aim of treatment is to reduce BP to 140/90 or less

Drug Treatmentyounger than 55

Step 1 : ACE inhibitor Step 2 : ACE inhibitor + Thiazide Diuretic or

ACE inhibitor + Calcium Channel Blocker Step 3: A + C +D Step 4: Further diuretic therapy, alpha or B-

blocker, or refer

55 years or older or Black patients of any age

Step 1 : C or D Step 2 : C + A or D + A Step 3 : A + C + D Step 4 : Add further diuretic therapy or alpha

or beta blocker or refer

If ACE inhibitor intolerant use A2RB

General Issues when Prescribing

Polypharmacy better to control hypertension Use Generic if available B-Blockers no longer 1st line, avoid in asthma

and in peripheral vascular disease If s/e unacceptable to patient stop drug

Investigations

Urine dipstick, protein/ glucose Bloods, cholesterol, fasting glucose, lipids,

renal function ECG

Lifestyle Interventions to reduce BP

Exercise Healthy diet Smoking cessation Moderate alcohol consumption Avoid excessive caffeine Reduce salt intake

Refer Immediately

If patient has malignant hypertension (>180/110 with signs of papillodema and/or retinal damage)

phaeochromocytoma

Follow up

Annual review Monitor BP Provide support Discuss lifestyles, symptoms, and medication

Any Questions?

The End