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NICE HYPERTENSION GUIDELINES

What's new?. Change in terminology for grades of HTNMethods of diagnosing BPUse of ABPM/HBPMInvestigating target organ damage

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NICE HYPERTENSION GUIDELINES

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    1. NICE HYPERTENSION GUIDELINES August 2011

    2. What’s new? Change in terminology for grades of HTN Methods of diagnosing BP Use of ABPM/HBPM Investigating target organ damage & calculating CV risk before definitive diagnosis Some alteration in details of recommended treatments This guideline doesn’t cover special groups – DM, secondary causes accelerated HTN or pregnant women or the youngThis guideline doesn’t cover special groups – DM, secondary causes accelerated HTN or pregnant women or the young

    3. Background No definitive ‘hypertensive’ point Continuous increase in CV risk 25% adults hypertensive, 50% of over 60y 12% of primary care consultations >£1 billion drug costs (2006) Impact of ageing population & lifestyle HTN defined as >140/90 for prevalence statistics HTN defined as >140/90 for prevalence statistics

    4. Diagnosis BP both arms If >140/90 then second +/- third measurement on same visit Record lowest BP as ‘clinic’ reading If discrepancy between arms >20mmHg, rpt again, then use arm with higher BP (guidelines didn’t mention coarctation etc??) Take a third BP measurement only if big discrepancy between readings 1 & 2 Record the lowest BP in records If discrepancy between arms >20mmHg, rpt again, then use arm with higher BP (guidelines didn’t mention coarctation etc??) Take a third BP measurement only if big discrepancy between readings 1 & 2 Record the lowest BP in records

    5. Diagnosis If clinic BP>140/90 Offer ambulatory BP monitoring (ABPM) HBPM alternative Assess for end organ damage & CV risk in all But…. Severe HTN – start Rx immediately Refer malignant HTN to secondary care HBPM if unable to tolerate ABPM Start Rx if ‘severe HTN’ rather than awaiting results. Refer those with malignant HTN, signs papilloedema etc the same day for hospital review as before. While waiting for ABPM/HBPM look for signs end organ damage (LVH, kidney/eyes) as well as assessing CV risk 10yrs – i.e. before definitive HTN diagnosisHBPM if unable to tolerate ABPM Start Rx if ‘severe HTN’ rather than awaiting results. Refer those with malignant HTN, signs papilloedema etc the same day for hospital review as before. While waiting for ABPM/HBPM look for signs end organ damage (LVH, kidney/eyes) as well as assessing CV risk 10yrs – i.e. before definitive HTN diagnosis

    6. Diagnosis When using ABPM to confirm diagnosis ensure: At least 2 measurements/hour during normal waking hours Average of at least 14 measurements to confirm diagnosis When using HBPM: 2 consecutive seated measurements at least 1 minute apart BP recorded twice a day for minimum 4d, ideally 7d Discard day 1 recordings, average of the remaining used Ideally HBM – morning & eveningIdeally HBM – morning & evening

    7. So why switch to ABPM? Review of evidence has shown ABPM away from clinic is the best predictor of BP related clinical outcomes. Not only a more accurate means of diagnosis but also more cost effective

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