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Investigation and Management of high blood pressure: primary and secondary care

Learn everything you need to know about blood pressure management, including reducing salt, alcohol, and weight, increasing aerobic exercise, and incorporating fruits/vegetables and oily fish into your diet. Discover the impact of high blood pressure on stroke and ischemic heart disease, as well as the observational and randomized data on blood pressure differences. Understand the causes and secondary factors of high blood pressure, and gain insights into the diagnosis and treatment guidelines.

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Investigation and Management of high blood pressure: primary and secondary care

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  1. Investigation and Management of high blood pressure:primary and secondary care Reecha Sofat, Ben Walsh, Raymond MacAllister University College London and Royal Free Hospital Cardiovasular Risk and Complex Hypertension Service

  2. All you need to know about blood pressure…

  3. Keep it simple, we do **reduce salt, alcohol and weight and increase aerobic exercise and fruit/veg /oily fish

  4. Stroke Ischaemic Heart disease

  5. End-point BP difference Observational Randomised (Expected) (Observed) Stroke 5mmHg 35-40% 42% (33-50) CHD 5mmHg 20-25% 14% (4-22) Collins et al., Lancet 1990

  6. Causes of high blood pressure Idiopathic, essential Overweight Alcohol Salt intake Sedentary lifestyle • Secondary Coarctation Renovascular Renal parenchymal Endocrine (Conn’s, Phaeochromocytoma) Drugs

  7. How do we manage BP at UCLH?

  8. Which guidelines do we use?

  9. Diagnosis of high blood pressure:ESH/ ESC guidance 2013

  10. Stroke Ischaemic Heart disease

  11. End-point BP difference Observational Randomised (Expected) (Observed) Stroke 5mmHg 35-40% 42% (33-50) CHD 5mmHg 20-25% 14% (4-22) Collins et al., Lancet 1990

  12. Regarding referrals • Do we accept referrals where 24 APBM has not been carried out? • Yes (2 office measures, 2 separate visits) • Is it a criteria for referral to UCLH or Royal Free services? • No • When do we use ABPM? • White coat and white coat in those with high BP, adherence monitoring

  13. Treatment of high blood pressure

  14. Two strategies • Lifestyle • Pharmacological

  15. Pharmacological , what do we know about the drugs use to lower BP?

  16. Problems or preferences of one drug class over another?

  17. Beta blockers and diabetes Glucose lowering anti-hypertensives Glucose raising anti-hypertensives 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Glucose mmol/L Sofat R et al., BMJ 2012

  18. Sofat R et al., BMJ 2012

  19. Management of High Blood Pressure In African American: Consensus statement of the hypertension in African Americans Working Group of the International Society on Hypertension in Blacks Arch Intern Med 2003; 163: 525 “All antihypertensive drug classes are associated with blood pressure lowering efficacy in African Americans. Thus in terms of efficacy, there is no rationale for using race as a reason to avoid certain classes of agents in African American patients with high blood pressure.”

  20. Drugs by age cut off?

  21. Which drug?

  22. Interpretation? • It’s the blood pressure that is important, regardless of the drug used to lower it

  23. What do we do at UCLH?

  24. What to expect when your patients are referred to UCLH BP clinic • History • Exam • If they have been difficult to manage screen for • Secondary causes • Adherence (DoT)

  25. Who to screen • Patients with ‘resistant’ hypertension (BP >140/90mmHg on 3 antihypertensives) • Young patients (<40) with high blood pressure • Patients presenting with accelerated hypertension • Hypertensive urgency vs emergency

  26. SIMPLIFY! **reduce salt, alcohol and weight and increase aerobic exercise and fruit/veg /oily fish

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