Download - NICE GUIDELINES HYPERTENSION Masroor Syed. Latest Issue June 2006 Evidence Based uickrefguide.pdf
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NICE GUIDELINESHYPERTENSION
Masroor Syed
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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
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Causes of Hypertension
Essential Renal Endocrine Pregnancy Miscellaneous including drugs
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Hypertension complications
Stroke IHD LVH and heart failure End organ damage
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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
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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
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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
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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
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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
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Investigations
Urine dipstick, protein/ glucose Bloods, cholesterol, fasting glucose, lipids,
renal function ECG
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Lifestyle Interventions to reduce BP
Exercise Healthy diet Smoking cessation Moderate alcohol consumption Avoid excessive caffeine Reduce salt intake
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Refer Immediately
If patient has malignant hypertension (>180/110 with signs of papillodema and/or retinal damage)
phaeochromocytoma
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Follow up
Annual review Monitor BP Provide support Discuss lifestyles, symptoms, and medication
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Any Questions?
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The End