Hypertension Guideline Implementation and Research Mark Caulfield For the British Hypertension Society The William Harvey Research Institute and Barts and The London NIHR Biomedical Research Unit Queen Mary University of London ABOUT THIS PRESENTATION: This presentation has been written to help you raise awareness of the NICE clinical guideline on hypertension. This guideline has been written for healthcare professionals caring for adults with hypertension in secondary care (excluding emergency care) and community settings in which NHS care is received. The guideline is available in a number of formats, including a quick reference guide. You may want to hand out copies of the quick reference guide at your presentation so that your audience can refer to it. See the end of the presentation for ordering details. You can add your own organisation’s logo alongside the NICE logo. We have included notes for presenters, broken down into ‘key points to raise’, which you can highlight in your presentation, and ‘additional information’ that you may want to draw on, such as a rationale or an explanation of the evidence for a recommendation. Where necessary, the recommendation will be given in full. DISCLAIMER This slide set is an implementation tool and should be used alongside the published guidance. This information does not supersede or replace the guidance itself. PROMOTING EQUALITY Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent with compliance with those duties. Launch: Wednesday 24th August 2011 NICE clinical guideline 127

Research Recommendations Out-of-office monitoring In adults with primary hypertension, does the use of out-of- office monitoring (HBPM or ABPM) improve response to treatment? Intervention thresholds for people aged under 40 with hypertension In people aged under 40yrs with hypertension, what are the appropriate thresholds for intervention?

Research Recommendations Methods of assessing lifetime CV risk in people aged under 40 with hypertension In people aged under 40yrs with hypertension, what is the most accurate method of assessing the lifetime risk of cardiovascular events and the impact of therapeutic intervention on this risk?

Research Recommendations Optimal systolic blood pressure In people with treated hypertension, what is the optimal systolic blood pressure? Step 4 treatment - resistant hypertension In adults with resistant hypertension, which drug treatment (diuretic therapy versus other step 4 treatments) is the most clinically and cost effective for step 4 treatment?

Research Recommendations Automated blood pressure monitoring in people with atrial fibrillation Which automated blood pressure monitors are suitable for people with hypertension and atrial fibrillation?

Hypertension Guideline Launch 24th August 2011 BHS Live! and implementation meeting BHS Information and Guidelines WP Lifestyle Combination therapies Secondary causes of hypertension Hypertension urgencies

Education and implementation Regional Meetings Edinburgh, Manchester, Birmmingham Several in Wales Northern Ireland Primary Care Meetings and Non-medical prescribers Nurse updates

Facilitating implementation Quality Outcomes Framework – adopting NICE on very elderly Pilot of ne QoF Targets Exploring possibility of National Procurement of ABPM Device manufacturers will need to look at pricing National ABPM registry and reporting system