Hypertension

Nick Price 22.8.07

Aim

• Consider the application of ‘evidence based practice’ in the management of hypertension in primary care.

• EBP – defined as the integration of best available research evidence with clinical expertise and patient values (Sackett et al, 2000)

Objectives

• Brief overview of NICE guidelines• Consider what this means in practice using

some examples from patients• Become familiar with cardiac risk calculations

and to be able to interpret what these mean.• Be able to explain this to patients

So what is hypertension all about?

Disease Orientated Outcomes

Patient Orientated Outcomes

Others’ Orientated Outcomes

• GPs• Practice nurses• PCTs• Secondary Care• Patient groups (e.g. BHF)• Professional groups (e.g. BHS)• Drug Companies• Government

What is hypertension?

• > 140/90 ?• > 180/110 ?• > 160/100 or 160/ or 140/90 and 10 year CVD

risk of > 20% or has end organ damage(NICE 2006)

Measurement considerations

• Techniques• No of readings• Cuffs• Home BP• Ambulatory

Investigations (order of priority??)

• Urine dipstix• U+E, creatinine (eGFR?)• TC + HDL• ECG

Rx?

• (Smoking)• (Low fat diet)• Exercise or physical activity• Low salt diet• Low alcohol• Low caffeine• Relaxation?• Types of fat?

Cardiac Risk Assessments

http://www.cvhealth.ed.ac.uk/othercalcs/cardiacrisk.html

http://www.patient.co.uk/showdoc/40000133/http://www.epi.bris.ac.uk/CVDethrisk/

Involving patients

Oh, OK then have some drugs!

• < 55yrs

A• > 55 or black patients

C or D

A+C or A+D

A+C+D

Summary – think carefully• Measurements• Interventions• Explaining to patients• Empowering vs disempowering patients• Use risk calculators• Non drug Rx is probably at least as effective as a

whole stack of medication• Integrate your patients values into the

management plan.• Don’t be bullied by QoF etc.