Learn How to Manage Hypertension Effectively?

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In this video, 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 NICE guidelines on the hypertension management
5. The important points about the anti-hypertensives

 

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Get you cheat sheet  here:  Management of Hypertension Made Easy – FREE Cheat Sheet!

 

Resources

Get you cheat sheet  here:  Management of Hypertension Made Easy – FREE Cheat Sheet!

For Australian students:

Hypertension Guidelines – Click Here

Clinical information: Click Here

Get the slide show: Click Here

 

Hypertension is always one of the difficult cases, that too in exams like CSA.

There are so many scenarios in Hypertension

1. Diagnosing

2. Treating

3. Changing treatments

4. Prevention

5. Referral criteria for the secondary care

6. REMEMBER:  DVLA Guidelines for HGV drivers.

MAGIC NUMBER TO REMEMBER – BP  >180/100.

 

Sky is the limit – Have FUN 🙂

Practice all the scenarios prior to your CSA Exam.

 

HYPERTENSION MANAGEMENT MADE EASY

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

Main point – 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.

Hoorayyyy! Recheck at least every 5 years.

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

 

 

FIRST STEP

ABPM is the BEST, But

The 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 carribean descent – Calcium channel blocker (CCB) – Use Amlodipine.

STEP – 2

Then ACE +CCB

STEP – 3

ACE + CCB + Thiazide-like Diuretics  

( Use Indapamide – NOT Bendroflumethazide )

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.

 

 

That’s all! Hooray!!!

STOP 🙂

You should know ONE MORE Thing!

 

 

WHEN TO STEP UP?

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.

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

 

 

Take Action NOW!

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

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

Please go through the example case scenarios with your friends!