Hypertension

All change: Using ambulatory blood pressure monitoring to diagnose hypertension in primary care

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?

Back to Basics 6 – Making sense of how antihypertensives work

Back to Basics: Making sense of how antihypertensives work

Making the numbers add up: diagnosing the one in four UK adults with hypertension

Hypertension – high blood pressure – is one of the key ingredients in the recipe for cardiovascular disease (CVD). Since April 2009 all patients diagnosed with hypertension should have a cardiovascular risk assessment carried out in order to meet the requirements of the Quality and Outcomes Framework (QOF). This reflects the importance of hypertension as a risk factor for CVD. In this article, we will review the correct method for measuring blood pressure and the key guidelines setting out how and when a diagnosis of hypertension should be made.

Standing up, sitting or lying down: what do these BP readings mean?

Maintaining a healthy blood pressure (BP) is important in preventing cardiovascular events such as heart attack and stroke, and measuring BP is a key step in cardiovascular risk assessment. However, it is not always measured correctly. Readings should be taken from both arms and the higher reading of the two, if there is a difference, should be used and a record should be kept of the preferred arm for future readings. But what about the patient’s position? Does a lying and standing measurement need to be done in all patients? What is an ‘acceptable’ difference? And does it matter?

Postural Hypotension

As we aim for tighter and tighter blood pressure control to minimise the cardiovascular complications of diabetes,the risk of postural hypotension increases. In this article we discuss what postural hypotension is and how to identify it and confirm diagnosis. We also consider the main causes and the relationship between diabetic neuropathy and postural hypotension as well as prevention and treatment strategies.

A case of paediatric hypertension

Diagnosing hypertension: getting the numbers right

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.

High blood pressure: only one number matters for patients over 50

The HYVET study: answering the question of whether or not to treat hypertension in the very elderly

Drugs acting on the renin-angiotensin system (RAS)

Aliskiren: the first direct renin inhibitorxfor hypertension

Aliskiren (Rasilez) is the first in a new class of medicines – the direct renin inhibitors – to treat high blood pressure to become available in more than a decade. In this article we review how aliskiren works, what makes it different from other drugs acting on the reninangiotensin system (RAS), its efficacy and tolerability and its likely place in the management of hypertension.

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