Hypertension

Hands on Hypertension: Getting to Targets in Practice

Hypertension affects one in five people in the UK and is poorly managed despite a range of drug and lifestyle interventions known to be useful and effective. We are constantly reminded about the importance of getting people to target with blood pressure (BP) treatments but this can be easier said than done. In this article, we will look at the challenge of getting blood pressure readings down to target levels and we will work through some case studies to explore possible solutions to achieving the targets in practice.

You And Your Treatment: Starting On Your ACE Inhibitor

Secondary Hypertension: Digging Beneath the Surface

Secondary hypertension, in which patients have an underlying cause for their raised blood pressure, occurs in about 5–10% of patients with high blood pressure. It is found more commonly in younger people. These patients can be identified by careful screening and as part of their initial assessment. In this article, we explore the possible causes of secondary hypertension, how to detect them and how they should be managed.

Blood Pressure: How Different Devices Measure Up

Successful combining of antihypertensive drugs

Hypertension (high blood pressure) is estimated to affect 60-70% of people aged over 60 years of age and increases the risk of complications such as coronary heart disease, heart failure and stroke. Although it is well accepted that lowering blood pressure is crucial in reducing overall cardiovascular morbidity and mortality, the number of people whose raised blood pressure is reduced below target levels remains defiantly low. In this article, we review why so many patients fail to reach blood pressure targets and how we can improve this, including use of more than one antihypertensive.

Managing Hypertension: Updated NICE Guideline

Which antihypertensives are best? Making sense of the ASCOT study

Newer’ antihypertensive therapy reduces cardiovascular events compared to ‘older’ drugs, according to the recently published Anglo-Scandinavian Cardiac Outcomes Trial – Blood Pressure Lowering Arm (ASCOT-BPLA). The results showed that antihypertensive therapy based on the calcium channel blocker amlodipine, with the ACE inhibitor perindopril added as required, reduced cardiovascular events compared with treatment based on the beta-blocker atenolol. In this article, we review what the findings mean for primary care management of high blood pressure and put them in perspective.

Back to Basics: Drugs to lower blood pressure

24-hour ambulatory blood pressure monitoring

Ambulatory blood pressure monitoring (ABPM) is used widely in secondary care hypertension clinics, so what about its use in the primary care setting, where the majority of hypertension clinics take place? What are the potential benefits of ambulatory monitoring? Which patients should ABPM be used for? In this article we review the nuts and bolts of ABPM – when to use it, how to perform the test to obtain an accurate assessment of 24-hour BP and how to apply the results in clinical practice.

Hypertension: the big one for QOF points

In the third article in our series on the Quality and Outcomes Framework (QOF) we are reviewing how to score top marks for hypertension. This is probably the most difficult condition to treat to target but with careful attention to regular monitoring of patients with high blood pressure, treatment based on latest guidelines and careful recording of the outcomes of patient consultations, all practices should be able to gain points in this area.

Changing practice in hypertension: ASCOT win for newer antihypertensives

The British Hypertension Society Guidelines published last year were widely welcomed as a major step forward in the management of patients with high blood pressure. In common with all recent guidelines they were based on a review of all relevant evidence, mainly gained from clinical trials. However, medicine is never static and research is ongoing. A major study – ASCOT – has provided new information about the benefits of newer combinations of antihypertensives compared to older drugs. What did the study show and how should we act on the results to improve outcomes for our patients?

Isolated systolic hypertension

Isolated systolic hypertension (ISH) – an increase in the higher of the two numbers when blood pressure (BP) is measured – is the commonest type of high BP in older people over the age of 60. The systolic pressure used to be dismissed as less important than the lower number – diastolic BP – but studies have shown that it is associated with increased risk of cardiovascular disease. ISH accounts for up to 75% of the overall incidence of uncontrolled hypertension in the elderly and appears to be more common in women than men.

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