Pocket Science - Hypertension 2nd edition
Dr Mark Davis
- Hypertension is one of the most important and preventable causes of morbidity and mortality globally. Large numbers of patients in the UK are considered to have hypertension.
- Individuals with hypertension are likely to have multiple risk factors for CVD, necessitating an assessment of overall cardiovascular risk and multiple drug intervention where indicated.
- Hypertension is still managed sub-optimally in UK primary care, although there are signs of recent improvement. Consequently, primary care faces a major challenge in improving the care of patients with hypertension.
- Guidelines provide us with clear and practical advice for the management of hypertension. However, new systems of healthcare delivery are needed to allow this guidance to be implemented effectively. The entire community healthcare team, including nurses and pharmacists, will be at the forefront of this strategy.
- Treatment is indicated when a patient has sustained blood pressure above 160/100 mmHg, but the threshold is lower in patients with diabetes and evidence of CVD. Patients with milder hypertension require risk assessment, which will drive the decision to treat.
- The 2006 NICE–BHS guidance revised the treatment algorithm based on the original BHS AB/CD algorithm, relegating beta blockers to fourth-line therapy in uncomplicated hypertension.
- Patients should be actively involved in the decisions about lifestyle changes and drug intervention.
- Clinical audit is now an essential part of primary care, driven by the quality standards in the GMS contract. It is likely that the quality indicators in this framework will be adopted as the basis for clinical audit in practices across the UK.