Transcript Hypertension - Bradford VTS

Hypertension
Nick Price 22.8.07
Aim
• Consider the application of ‘evidence based
practice’ in the management of hypertension
in primary care.
• EBP – defined as the integration of best
available research evidence with clinical
expertise and patient values (Sackett et al,
2000)
Objectives
• Brief overview of NICE guidelines
• Consider what this means in practice using
some examples from patients
• Become familiar with cardiac risk calculations
and to be able to interpret what these mean.
• Be able to explain this to patients
So what is hypertension all about?
Disease Orientated Outcomes
Patient Orientated Outcomes
Others’ Orientated Outcomes
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GPs
Practice nurses
PCTs
Secondary Care
Patient groups (e.g. BHF)
Professional groups (e.g. BHS)
Drug Companies
Government
What is hypertension?
• > 140/90 ?
• > 180/110 ?
• > 160/100 or 160/ or 140/90 and 10 year CVD
risk of > 20% or has end organ damage
(NICE 2006)
Measurement considerations
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Techniques
No of readings
Cuffs
Home BP
Ambulatory
Investigations (order of priority??)
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Urine dipstix
U+E, creatinine (eGFR?)
TC + HDL
ECG
Rx?
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(Smoking)
(Low fat diet)
Exercise or physical activity
Low salt diet
Low alcohol
Low caffeine
Relaxation?
Types of fat?
Cardiac Risk Assessments
http://www.cvhealth.ed.ac.uk/othercalcs/cardia
crisk.html
http://www.patient.co.uk/showdoc/40000133/
http://www.epi.bris.ac.uk/CVDethrisk/
Involving patients
Oh, OK then have some drugs!
• < 55yrs
• > 55 or black patients
A
C or D
A+C or A+D
A+C+D
Summary – think carefully
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Measurements
Interventions
Explaining to patients
Empowering vs disempowering patients
Use risk calculators
Non drug Rx is probably at least as effective as a
whole stack of medication
• Integrate your patients values into the
management plan.
• Don’t be bullied by QoF etc.