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NICE/BHS Hypertension Guideline Review 28 June 2006

Validated Blood Pressure Monitor Lists . ESH Clinical Hypertension Specialists . Latest BHS Management Guidelines . Validated Blood Pressure Monitor Lists . BHS Live! - 3 VALUE. Hypertension Management Guidelines. Hypertension Management Guidelines. BHS Live! - 3 VALUE.

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NICE/BHS Hypertension Guideline Review 28 June 2006

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  1. Validated Blood Pressure Monitor Lists  ESH Clinical Hypertension Specialists  Latest BHS Management Guidelines  Validated Blood Pressure Monitor Lists  BHS Live! - 3 VALUE Hypertension Management Guidelines Hypertension Management Guidelines BHS Live! - 3 VALUE Latest BHS Management Guidelines  ESH Clinical Hypertension Specialists  Hypertension Management Guidelines Latest BHS Management Guidelines  Hypertension Management Guidelines ESH Clinical Hypertension Specialists  BHS Live! - 3 VALUE ESH Clinical Hypertension Specialists  BHS Live! - 3 VALUE Validated Blood Pressure Monitor Lists  Latest BHS Management Guidelines  Validated Blood Pressure Monitor Lists  BHS Statement on the ALLHAT Trial BHS Statement on the ALLHAT Trial NICE/BHS Guidelines NICE/BHS Guidelines European Society of Hypertension Specialist Accreditation Blood Pressure-related Papers  How to Measure Blood Pressure European Society of Hypertension Specialist Accreditation NICE/BHS Guidelines How to Measure Blood Pressure NICE/BHS Guidelines BHS Statement on the ALLHAT Trial Blood Pressure-related Papers  How to Measure Blood Pressure European Society of Hypertension Specialist Accreditation BHS Statement on the ALLHAT Trial European Society of Hypertension Specialist Accreditation Blood Pressure-related Papers  Blood Pressure-related Papers  How to Measure Blood Pressure Other Guidelines Other Guidelines Publications Factfiles Statement from the ASCOT Executive  UK Hypertension Referral Centres  Publications UK Hypertension Referral Centres  Other Guidelines Factfiles Publications Statement from the ASCOT Executive  Statement from the ASCOT Executive  Statement from the ASCOT Executive  Factfiles UK Hypertension Referral Centres  Other Guidelines UK Hypertension Referral Centres  Publications Factfiles BHS-PCCS Live ONTARGET Clinical Excellence Awards  CVD Risk Charts and Calculators Healthy Eating CVD Risk Charts and Calculators BHS-PCCS Live ONTARGET Clinical Excellence Awards  Healthy Eating CVD Risk Charts and Calculators BHS-PCCS Live ONTARGET CVD Risk Charts and Calculators BHS-PCCS Live ONTARGET Clinical Excellence Awards  Healthy Eating Healthy Eating Clinical Excellence Awards  Other Related Publications Clinical Research  Other Related Publications How to Measure Blood Pressure Clinical Research  Clinical Research  Other Related Publications How to Measure Blood Pressure Clinical Research  Other Related Publications How to Measure Blood Pressure How to Measure Blood Pressure Therapeutics Therapeutics Therapeutics Factfiles Factfiles Factfiles Therapeutics Factfiles NICE/BHS Hypertension Guideline Review 28 June 2006 John Barker

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

  3. When to measure BP • Every 5 yrs to age 80 • Annually 130-139 over 85-89

  4. Measure BP • Warm relaxed environment • Position • Both arms • If raised twice! • Come back…. Monthly – sooner if higher • 140/90

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

  6. 140 / 90 160 / 100 Recheck Treat Levels

  7. High Risk Endorgan Damage Diabetes Target 140 / 90 140 / 90 Levels - treatment

  8. No Nephropathy Nephropathy – start ACE Proteinuria Rx at 140 / 90 Aim 130 / 80 Aim 130 / 80 Aim 125 / 75 Diabetes T1/2 - 2004

  9. Diabetes T2 – 2008

  10. 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

  11. 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?

  12. Endorgan Damage CVD disease Co-morbidity Diabetes Chronic Kidney Disease Other increased Risk

  13. Accellerated HT 180/110 Papilloedema or symptoms Phaeochromocytoma Unusual Postural Hypotension Secondary cause suspected Risk - Refer

  14. Tests • Urine – protein • Plasma • Glucose • U+E / Creatinine • Cholesterol / HDL • ECG

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

  16. Lifestyle • Diet and Exercise • Alcohol • Coffee / Caffeine • Salt • Smoking

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

  18. <55 >55, Black / African Antihypertensives – newly diagnosed

  19. Antihypertensives • Betablockers • Thiazides • Pregnancy • Alpha Blockers

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

  21. Annual Monthly (if not stable) Less than monthly if High risk Monitoring

  22. 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

  23. Journal Pre Breakfast Post lunch Pre evening meal Night time 4.3 8.0 6.0 7 AKT Question?

  24. AKT Question? • What therapeutic option should be taken? • Bispoprolol • dipeptidyl peptidase-IV inhibitor (DPP-IV) • Increase bolus insulin • Ramipril • Increase basal insulin

  25. AKT Answer • Add ACE inhibitor as has nephropathy • Hopefully his BP will tollerate it!

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