nice/bhs hypertension guideline review 28 june 2006 john barker esh clinical hypertension...

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!