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Management of Hypertension Made Easy – FREE Cheat Sheet!

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It helped me a lot, not only in my exams but also in day-to-day GP Surgery to manage Hypertension easily.

Hope you feel confident to deal it!

Here you go 🙂

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HYPERTENSION MANAGEMENT MADE EASY!

(Practice each scenario separately, double-check with NICE/ local guidelines/ BNF )

The main point is 

Single BP reading NOT ESTABLISH the diagnosis.

So, IF BP >140/90, REPEAT 2 more times.

Record the lower of the last reading.

NOW WE CAN HAVE THREE SCENARIOS.

1. BP > 180/110 – SEVERE Hypertension

THINK – ?Pheochromocytoma /?accelerated hypertension/Consider admission.

(NICE recommend immediate drug therapy) Usually, repeat BP in a few days.

2. BP < 140/90 – Normotensive  —- Recheck at least every 5 years.

3. BP >140/90 but <180/110 – NOT Tricky!!!

 

If the clinic blood pressure is 140/90 mmHg or higher, offer ABPM to confirm the diagnosis of hypertension.
If a person is unable to tolerate ABPM, HBPM is a suitable alternative to confirm the diagnosis of hypertension.
While waiting to confirm the diagnosis, carry out investigations for target organ damage and a formal assessment of cardiovascular risk.

 

 

FIRST STEP

ABPM is the BEST, But

If ABPM not tolerated, Patient can choose either Home BP reading (HBPM) or Clinic Reading once with Healthcare Assistant.

1. Home BP Reading – (2 times daily for 5 days) Discard the 1st days reading – Average the remaining.

2. HCA BP reading , if still elevated –  Fit ABPM.  (At least 14 readings, Daytime only)

 

 

SECOND STEP

After ABPM/Home readings –

If BP <135/85 – Normotensive.

If BP > 135/85 — confirmed HYPERTENSION.

 

 

 

THIRD STEP

Remember –

3 things to do in your third step!

1. Look for end organ damage

  • ECG
  • Bloods – Glu, U&E/eGFR, Cholesterol, HDL, CRP ( to exclude secondary causes)
  • Urine for ACR & Dipstick for haematuria
  • Fundi for hypertensive retinopathy. ( Remember to tell in CSA & Practice how to explain the procedure)

2. Assess CVD Risk with QRISK.

3. Start lifestyle counselling.

NOW CHECK-

WHAT IS THE AVERAGE BP in ABPM/ HBPM?

If BP > 150/95 – Stage 2 Hypertension – OFFER TREATMENT.

If BP between 135/85 and 149/94 – Stage 1 Hypertension

 

 

Now,

Only TWO Things To Check

End organ damage and 10 yr CVD Risk.

 

If 10 yr CVD Risk >20%   OR  End organ damaged – OFFER TREATMENT.

 

IF 10 yr CVD Risk <20% AND  NO End organ damage – Borderline Hypertension

–  For Annual Review.

Anti- Hypertensives are NOT recommended.

 

 

ANTI- HYPERTENSIVE TREATMENT

STEP – 1

It depends on AGE & Ethnicity

AGE <55 – ACE Inhibitor (Check U&E S 2 w after starting/dose increase)- Use Enalapril or Lisinopril.

AGE >55  OR  Afro-Caribbean descent – Calcium channel blocker (CCB) – Use Amlodipine.

STEP – 2

Then ACE +CCB

STEP – 3

ACE + CCB + Thiazide-like Diuretics  

( Use Indapamide – NOT Bendroflumethiazide )

STEP – 4

ACE+ CCB+ Thiazide Diuretics + further Diuretics ( Spironolactone) OR  Alpha  OR  Beta Blocker

AND consider SPECIALIST referral.

 

Beta-blockers are not preferred in step 1. However, they may be considered for younger people if ACE inhibitors and ARBs are contraindicated or not tolerated or there is evidence of increased sympathetic drive, and for women of child-bearing potential.

 

In this webinar workshop, you will learn about

1. The important points in the management of hypertension
2. All the investigations needed to assess the end organ damage
3. How to manage different patients with example scenarios
4. The latest guidelines on the hypertension management
5. The important points about the anti-hypertensives

 

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That’s all…

Hooray!!!

 

STOP…..

You should know ONE MORE Thing :-)

 

 

WHEN TO STEP UP? (very important for CSA)

Depends on age & BP measurement method.

Add additional therapy if the following BP targets are not achieved.

 

BP TARGET SHOULD BE 

If  <80 yrs –  Clinic BP <140/90 OR  ABPM /Home reading < 135/85

If  > 80 yrs – Clinic BP <150/90 and    ABPM /Home reading <145/85. ( very rare to get this case in CSA)

(Bit relaxed –  Diastolic remains the same as <80s)

 

 

Take Action NOW!

Comment Below – What is the single biggest insight you got?

And what action will you take right now to implement it?

 

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Talk soon,

hemasign

Dr. Hema 

 

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