nice/bhs hypertension guideline review 28 june 2006 john barker esh clinical hypertension...
DESCRIPTION
When to measure BP Every 5 yrs to age 80 Annually over 85-89TRANSCRIPT
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NICE/BHS Hypertension Guideline Review 28 June
2006
John Barker
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1. Have they got HT? 2. Assess risk of Cardiovascular Disease 3. Lifestyle and blood pressure
• smoking• diet and exercise
4. Antihypertensives 5. Monitoring
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When to measure BP
• Every 5 yrs to age 80
• Annually 130-139 over 85-89
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Measure BP
• Warm relaxed environment• Position• Both arms• If raised twice!
• Come back…. Monthly – sooner if higher
• 140/90
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1. Have they got HT? 2. Assess risk of Cardiovascular Disease 3. Lifestyle and blood pressure
• smoking• diet and exercise
4. Antihypertensives 5. Monitoring
![Page 6: NICE/BHS Hypertension Guideline Review 28 June 2006 John Barker ESH Clinical Hypertension Specialists European Society of Hypertension Specialist Accreditation](https://reader035.vdocument.in/reader035/viewer/2022062905/5a4d1ace7f8b9ab0599709b3/html5/thumbnails/6.jpg)
Levels
140 / 90
160 / 100
Recheck
Treat
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Levels - treatment
• High Risk• Endorgan
Damage• Diabetes
• Target
•140 / 90
•140 / 90
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Diabetes T1/2 - 2004
• No Nephropathy
• Nephropathy – start ACE
• Proteinuria
• Rx at 140 / 90• Aim 130 / 80
• Aim 130 / 80• Aim 125 / 75
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Diabetes T2 – 2008
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• Measure BP annually if not hypertensive or with renal disease.
• If BP > target, repeat measurement within:● 1 month if > 150/90 mmHg● 2 months if > 140/80 mmHg● 2 months if > 130/80 mmHg and kidney,
eye or cerebrovascular damage
Diabetes T2 – 2008
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Other increased risk?
• FH Man<55, Lady<65• FH More than one
relative• South Asian Man• BMI >40• > age 75• HDL M<1, L<1.2• Trig >1.7• BMI >30• Impaired Gluc Toll
Multiply by…• 1.3 (NICE 1.5)• 1.5 to 2.0
• 1.4• Higher• Higher
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Other increased Risk
• Endorgan Damage• CVD disease• Co-morbidity
– Diabetes– Chronic Kidney
Disease
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Risk - Refer• Accellerated HT
– 180/110– Papilloedema or– symptoms
• Phaeochromocytoma
• Unusual• Postural
Hypotension• Secondary cause
suspected
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Tests
• Urine – protein• Plasma
– Glucose– U+E / Creatinine– Cholesterol / HDL
• ECG
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1. Have they got HT? 2. Assess risk of Cardiovascular Disease 3. Lifestyle and blood pressure
• smoking• diet and exercise
4. Antihypertensives 5. Monitoring
![Page 17: NICE/BHS Hypertension Guideline Review 28 June 2006 John Barker ESH Clinical Hypertension Specialists European Society of Hypertension Specialist Accreditation](https://reader035.vdocument.in/reader035/viewer/2022062905/5a4d1ace7f8b9ab0599709b3/html5/thumbnails/17.jpg)
Lifestyle
• Diet and Exercise• Alcohol• Coffee / Caffeine • Salt• Smoking
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1. Have they got HT? 2. Assess risk of Cardiovascular Disease 3. Lifestyle and blood pressure
• smoking• diet and exercise
4. Antihypertensives 5. Monitoring
![Page 19: NICE/BHS Hypertension Guideline Review 28 June 2006 John Barker ESH Clinical Hypertension Specialists European Society of Hypertension Specialist Accreditation](https://reader035.vdocument.in/reader035/viewer/2022062905/5a4d1ace7f8b9ab0599709b3/html5/thumbnails/19.jpg)
Antihypertensives – newly diagnosed
<55 >55, Black / African
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Antihypertensives
• Betablockers• Thiazides• Pregnancy• Alpha Blockers
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1. Have they got HT? 2. Assess risk of Cardiovascular Disease 3. Lifestyle and blood pressure
• smoking• diet and exercise
4. Antihypertensives 5. Monitoring
![Page 22: NICE/BHS Hypertension Guideline Review 28 June 2006 John Barker ESH Clinical Hypertension Specialists European Society of Hypertension Specialist Accreditation](https://reader035.vdocument.in/reader035/viewer/2022062905/5a4d1ace7f8b9ab0599709b3/html5/thumbnails/22.jpg)
Monitoring
• Annual• Monthly (if not stable)• Less than monthly if
High risk
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AKT Question?• A 29 yr gentleman presents for diabetic review• He does not report any particular issues• Retinal screen shows some minor diabetic
retinopathy• He is currently on basal bolus regimen• 10 units of long acting insulin and 3-5units of
short acting prior to meals• BP 130 / 70• His HbA1C is 5.3 • Alb / Creat ratio is 4
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AKT Question?Journal
• Pre Breakfast
• Post lunch
• Pre evening meal
• Night time
• 4.3
• 8.0
• 6.0
• 7
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AKT Question?
• What therapeutic option should be taken?
• Bispoprolol• dipeptidyl peptidase-IV inhibitor (DPP-IV)• Increase bolus insulin• Ramipril• Increase basal insulin
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AKT Answer
• Add ACE inhibitor as has nephropathy• Hopefully his BP will tollerate it!