nice/bhs hypertension guideline review 28 june 2006 john barker esh clinical hypertension...
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When to measure BP Every 5 yrs to age 80 Annually over 85-89TRANSCRIPT
NICE/BHS Hypertension Guideline Review 28 June
2006
John Barker
1. Have they got HT? 2. Assess risk of Cardiovascular Disease 3. Lifestyle and blood pressure
• smoking• diet and exercise
4. Antihypertensives 5. Monitoring
When to measure BP
• Every 5 yrs to age 80
• Annually 130-139 over 85-89
Measure BP
• Warm relaxed environment• Position• Both arms• If raised twice!
• Come back…. Monthly – sooner if higher
• 140/90
1. Have they got HT? 2. Assess risk of Cardiovascular Disease 3. Lifestyle and blood pressure
• smoking• diet and exercise
4. Antihypertensives 5. Monitoring
Levels
140 / 90
160 / 100
Recheck
Treat
Levels - treatment
• High Risk• Endorgan
Damage• Diabetes
• Target
•140 / 90
•140 / 90
Diabetes T1/2 - 2004
• No Nephropathy
• Nephropathy – start ACE
• Proteinuria
• Rx at 140 / 90• Aim 130 / 80
• Aim 130 / 80• Aim 125 / 75
Diabetes T2 – 2008
• 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
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
Other increased Risk
• Endorgan Damage• CVD disease• Co-morbidity
– Diabetes– Chronic Kidney
Disease
Risk - Refer• Accellerated HT
– 180/110– Papilloedema or– symptoms
• Phaeochromocytoma
• Unusual• Postural
Hypotension• Secondary cause
suspected
Tests
• Urine – protein• Plasma
– Glucose– U+E / Creatinine– Cholesterol / HDL
• ECG
1. Have they got HT? 2. Assess risk of Cardiovascular Disease 3. Lifestyle and blood pressure
• smoking• diet and exercise
4. Antihypertensives 5. Monitoring
Lifestyle
• Diet and Exercise• Alcohol• Coffee / Caffeine • Salt• Smoking
1. Have they got HT? 2. Assess risk of Cardiovascular Disease 3. Lifestyle and blood pressure
• smoking• diet and exercise
4. Antihypertensives 5. Monitoring
Antihypertensives – newly diagnosed
<55 >55, Black / African
Antihypertensives
• Betablockers• Thiazides• Pregnancy• Alpha Blockers
1. Have they got HT? 2. Assess risk of Cardiovascular Disease 3. Lifestyle and blood pressure
• smoking• diet and exercise
4. Antihypertensives 5. Monitoring
Monitoring
• Annual• Monthly (if not stable)• Less than monthly if
High risk
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
AKT Question?Journal
• Pre Breakfast
• Post lunch
• Pre evening meal
• Night time
• 4.3
• 8.0
• 6.0
• 7
AKT Question?
• What therapeutic option should be taken?
• Bispoprolol• dipeptidyl peptidase-IV inhibitor (DPP-IV)• Increase bolus insulin• Ramipril• Increase basal insulin
AKT Answer
• Add ACE inhibitor as has nephropathy• Hopefully his BP will tollerate it!