NICE Guideline Synopsis

Definitions

Stage 1 HypertensionClinic BP 140/90 or higher And ABPM Daytime average/HBPM 135/85 or

higher

Definitions

Stage 2 HypertensionClinic BP 160/100 or higherAnd ABPM Daytime average/HBPM 150/95 or

higher

Definitions

Severe HypertensionClinic BP 180 systolic or higher or diastolic

110 or higher

DiagnosisIf clinic BP >140/90 then offer ABPM

ABPM should have at least 2 readings per hr in persons normal waking hours (usually 8-22.00)

Average of at least 14 readings required

Offer HBPM if ABPM is deemed unacceptable

BP should be taken in both arms-if difference >20mmHg use highest reading arm for subsequent reading

HBPMBP taken BD for minimum of 4 days but

ideally 7 days

Ideally morning and evening

2 BP readings done each time with patient seated and 1 minute apart

Discard readings done on day 1 and average remaining readings

TreatmentStage 1 Hypertension (=/>140/90 or 135/85)

<80Target organ damage (urine dip, ecg, fundi,

U&E, chol, BG)Renal diseaseCVDDiabetes10y CVD risk of 20% or higher

Stage 2 Hypertension (=/> 160/100 or 150/95)Any age

Severe HypertensionConsider starting medication same day

Specialist IxIf secondary causes suspectedSame day referral if concerns re accelerated

htn- BP >180/110 with papilloedema/retinal haemorrhage or suspected phaeochromocytoma (headache, labile/postural hypotension, pallor, palpitations and diaphoresis)

Young People<40 with Stage 1 Hypertension but no signs

of end organ damage/CVD/renal disease/diabetes consider specialist referral for further investigation of secondary causes as 10y CVD risk assessment underestimates risk in these people

Treatments<55y >55y or black Afro

Carribean1. ACEi/ARB2. CCB3. Thiazide like diuretic4. Low dose spironolactone

(25mg bd)if K<4.5. If K >4.5 consider higher dose thiazide diuretic

5. B blocker may be considered alternative to ACEi in young people/women of childbearing age

1. CCB (Thiazide like diuretic if heart failure/risk of/oedema/intolerance)

2. ACEi (ARB for black afrocaribean)

3. Thiazide like diuretic4. Low dose

spironolactone (25mg bd)if K<4.5. If K >4.5 consider higher dose thiazide diuretic

If treatment with a thiazide like diuretic is started or changed then use indapamide (1.25mg MR od or 2.5mg od) or chlortalidone (12.5-25mg od)

What About Lifestyle Advice?

Smoking/alcoholExerciseKeeping salt lowDiscourage excess caffeineRelaxation techniques if pt interestedAdvice re local initiatives for lifestyle help

TargetsClinic Readings ABPM/HBPM

<80 y<140/90

>80y<150/90

<80 y<135/85

>80y<145/85