1. NICE GUIDELINES HYPERTENSION Masroor Syed

2. Latest Issue June 2006 Evidence Based http://www.nice.org.uk/nicemedia/pdf/cg034q uickrefguide.pdf http://www.nice.org.uk/nicemedia/pdf/cg034q uickrefguide.pdf Important to be aware of this topic for both AKT and CSA as it is bound to come up

3. Causes of Hypertension Essential Renal Endocrine Pregnancy Miscellaneous including drugs

4. Hypertension complications Stroke IHD LVH and heart failure End organ damage

5. Measuring Blood Pressure Hypertension according to nice is a BP of greater than 140/90 (QOF > 150/90) Need at least two further readings of > 140/90 in order to diagnose hypertension Take these measurements one month apart or earlier if severe hypertension In diabetics hypertension BP> 130/80

6. Threshold for offering drug treatment BP > 140/90 if CVD risk of greater than 20% over 10 years use Framingham graphs BP> 140/90 and existing CVD or target organ damage Aim of treatment is to reduce BP to 140/90 or less

7. Drug Treatment younger than 55 Step 1 : ACE inhibitor Step 2 : ACE inhibitor + Thiazide Diuretic or ACE inhibitor + Calcium Channel Blocker Step 3: A + C +D Step 4: Further diuretic therapy, alpha or B- blocker, or refer

8. 55 years or older or Black patients of any age Step 1 : C or D Step 2 : C + A or D + A Step 3 : A + C + D Step 4 : Add further diuretic therapy or alpha or beta blocker or refer If ACE inhibitor intolerant use A2RB

9. General Issues when Prescribing Polypharmacy better to control hypertension Use Generic if available B-Blockers no longer 1 st line, avoid in asthma and in peripheral vascular disease If s/e unacceptable to patient stop drug

10. Investigations Urine dipstick, protein/ glucose Bloods, cholesterol, fasting glucose, lipids, renal function ECG

11. Lifestyle Interventions to reduce BP Exercise Healthy diet Smoking cessation Moderate alcohol consumption Avoid excessive caffeine Reduce salt intake

12. Refer Immediately If patient has malignant hypertension (>180/110 with signs of papillodema and/or retinal damage) phaeochromocytoma

13. Follow up Annual review Monitor BP Provide support Discuss lifestyles, symptoms, and medication

14. Any Questions?

15. The End