Transcript NICE GUIDELINES HYPERTENSION

NICE GUIDELINES
HYPERTENSION
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
Causes of Hypertension
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Essential
Renal
Endocrine
Pregnancy
Miscellaneous including drugs
Hypertension complications
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Stroke
IHD
LVH and heart failure
End organ damage
Measuring Blood Pressure
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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
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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 Treatment
younger than 55
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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 Bblocker, or refer
55 years or older or Black
patients of any age
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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
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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
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Urine dipstick, protein/ glucose
Bloods, cholesterol, fasting glucose, lipids,
renal function
ECG
Lifestyle Interventions to
reduce BP
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Exercise
Healthy diet
Smoking cessation
Moderate alcohol consumption
Avoid excessive caffeine
Reduce salt intake
Refer Immediately
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If patient has malignant hypertension
(>180/110 with signs of papillodema and/or
retinal damage)
phaeochromocytoma
Follow up
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Annual review
Monitor BP
Provide support
Discuss lifestyles, symptoms, and medication
Any Questions?
The End