Measuring blood pressure (BP) is one of the commonest tests we carry out in primary care – generally taking several measurements with a digital BP monitor on at least two clinic visits before diagnosing hypertension. Ambulatory blood pressure monitoring (ABPM) has traditionally been used in secondary care hypertension clinics, and in some larger general practices. But new guidelines from the National Institute for Health and Clinical Excellence are making ambulatory monitoring part of routine practice for the diagnosis of hypertension in primary care. What are the new guidelines recommending and why the change to ABPM?
This month’s Back to Basics focuses on the different drugs used in the management of hypertension. The wallchart provides a useful summary of the different antihypertensive drug classes and how they act to regulate blood pressure.
This useful wallchart gives at-a-glance advice on diagnosis and treatment of high blood pressure in adults, based on the most recent hypertension guidelines from NICE.
As many as 16 million people in the UK are estimated to have hypertension, and around 7 million of these are undiagnosed. Of those diagnosed in England, one third are not receiving optimum management. Poor detection and management of hypertension places a significant burden on the NHS, and hypertension-related conditions cost an estimated £2 billion a year. We can change this by raising awareness of the consequences of hypertension, making it simpler to diagnose, and by supporting patients to manage their own health. The benefits of doing this are huge – just a 15% increase in the number of adults in England who have had their hypertension diagnosed would add 7,000 qualityadjusted life years and reduce health and social care costs by £120 m over ten years.
In the first 15 months of its operation, Bradford’s Healthy Hearts campaign has significantly improved the cardiovascular health of local people, and saved an estimated £1.2 m for the clinical commissioning group.
Cardiovascular disease (CVD) is the leading cause of death worldwide. Elevated blood pressure (BP) is the main global risk factor for premature morbidity and mortality, and the prevalence of hypertensive heart disease is not declining over time. Improved control of high BP is, therefore, fundamental to further prevention of CVD, and adoption of treatment guidelines can have a positive impact on BP-related outcomes.
Hypertension is a silent, malevolent factor in both cardiovascular and renal disease. Raised blood pressure (BP) rarely causes any symptoms – in fact the presenting symptom of hypertension is too often the heart attack or stroke that is the end result. Diagnosis of prolonged abnormal blood pressure is therefore key in the prevention of a range of long-term conditions. In this article, we will examine the importance of measuring blood pressure correctly before making the diagnosis of hypertension. We will also look at the different levels of blood pressure that constitute a diagnosis of hypertension according to the variety of guidelines that exist.
Sleep apnoea is far more than just snoring associated with brief periods of suspended breathing while asleep. It is an important risk factor for cardiovascular disease and diabetes, so it is well worth asking patients whether they suffer breathing problems during the night and then following up those who do. More than one-third of people with sleep apnoea have hypertension, so measuring blood pressure is important in assessing risk factors and then establishing appropriate preventive treatment.
The angiotensin -receptor/neprilysin inhibitor Entresto™ (sacubitril/valsartan) is now available in the UK for treatment of adults with symptomatic chronic heart failure with reduced ejection fraction (HFrEF). The drug has been shown to have a significant mortality benefit in a head-to-head trial versus the ACE-inhibitor enalapril with an absolute risk reduction of 4.7%.