NICE/BHS Hypertension Guideline Review 28 June 2006

1
NICE/BHS Hypertension Guideline Review 28 June
2006
ESH Clinical Hypertension Specialists   
Validated Blood Pressure Monitor Lists   
Latest BHS Management Guidelines   
Hypertension Management Guidelines  
BHS Live! - 3 VALUE  
ESH Clinical Hypertension Specialists   
Validated Blood Pressure Monitor Lists   
Latest BHS Management Guidelines   
Hypertension Management Guidelines  
BHS Live! - 3 VALUE  
ESH Clinical Hypertension Specialists   
Validated Blood Pressure Monitor Lists   
Latest BHS Management Guidelines   
Hypertension Management Guidelines  
BHS Live! - 3 VALUE  
ESH Clinical Hypertension Specialists   
Validated Blood Pressure Monitor Lists   
Latest BHS Management Guidelines   
Hypertension Management Guidelines  
BHS Live! - 3 VALUE  
European Society of Hypertension Specialist Accred
itation  
How to Measure Blood Pressure  
NICE/BHS Guidelines  
Blood Pressure-related Papers   
BHS Statement on the ALLHAT Trial  
European Society of Hypertension Specialist Accred
itation  
How to Measure Blood Pressure  
NICE/BHS Guidelines  
Blood Pressure-related Papers   
BHS Statement on the ALLHAT Trial  
European Society of Hypertension Specialist Accred
itation  
How to Measure Blood Pressure  
NICE/BHS Guidelines  
Blood Pressure-related Papers   
BHS Statement on the ALLHAT Trial  
European Society of Hypertension Specialist Accred
itation  
How to Measure Blood Pressure  
NICE/BHS Guidelines  
Blood Pressure-related Papers   
BHS Statement on the ALLHAT Trial  
UK Hypertension Referral Centres   
Publications  
Other Guidelines  
Factfiles  
Statement from the ASCOT Executive   
UK Hypertension Referral Centres   
Publications  
Other Guidelines  
Factfiles  
Statement from the ASCOT Executive   
UK Hypertension Referral Centres   
Publications  
Other Guidelines  
Factfiles  
Statement from the ASCOT Executive   
UK Hypertension Referral Centres   
Publications  
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• John Barker

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 




                                                      
                                                      
                                                      
                                                      
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• Have they got HT?
• Assess risk of Cardiovascular Disease
• Lifestyle and blood pressure
• smoking
• diet and exercise
• Antihypertensives
• 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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• Have they got HT?
• Assess risk of Cardiovascular Disease
• Lifestyle and blood pressure
• smoking
• diet and exercise
• Antihypertensives
• Monitoring

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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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Diabetes T2 2008

• Measure BP annually if not hypertensive or with
  renal disease.
• If BP gt target, repeat measurement within
• ? 1 month if gt 150/90 mmHg
• ? 2 months if gt 140/80 mmHg
• ? 2 months if gt 130/80 mmHg and kidney, eye or
  cerebrovascular damage

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(No Transcript)
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Other increased risk?

• FH Manlt55, Ladylt65
• FH More than one relative
• South Asian Man
• BMI gt40
• gt age 75
• HDL Mlt1, Llt1.2
• Trig gt1.7
• BMI gt30
• 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
• UE / Creatinine
• Cholesterol / HDL
• ECG

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• Have they got HT?
• Assess risk of Cardiovascular Disease
• Lifestyle and blood pressure
• smoking
• diet and exercise
• Antihypertensives
• Monitoring

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Lifestyle

• Diet and Exercise
• Alcohol
• Coffee / Caffeine
• Salt
• Smoking

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• Have they got HT?
• Assess risk of Cardiovascular Disease
• Lifestyle and blood pressure
• smoking
• diet and exercise
• Antihypertensives
• Monitoring

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Antihypertensives newly diagnosed

• lt55

• gt55, Black / African

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Antihypertensives

• Betablockers
• Thiazides
• Pregnancy
• Alpha Blockers

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• Have they got HT?
• Assess risk of Cardiovascular Disease
• Lifestyle and blood pressure
• smoking
• diet and exercise
• Antihypertensives
• Monitoring

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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!