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Hypertension

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  1. Hypertension Nick Price 22.8.07

  2. Aim • Consider the application of ‘evidence based practice’ in the management of hypertension in primary care. • EBP – defined as the integration of best available research evidence with clinical expertise and patient values (Sackett et al, 2000)

  3. Objectives • Brief overview of NICE guidelines • Consider what this means in practice using some examples from patients • Become familiar with cardiac risk calculations and to be able to interpret what these mean. • Be able to explain this to patients

  4. So what is hypertension all about?

  5. Disease Orientated Outcomes

  6. Patient Orientated Outcomes

  7. Others’ Orientated Outcomes • GPs • Practice nurses • PCTs • Secondary Care • Patient groups (e.g. BHF) • Professional groups (e.g. BHS) • Drug Companies • Government

  8. What is hypertension? • > 140/90 ? • > 180/110 ? • > 160/100 or 160/ or 140/90 and 10 year CVD risk of > 20% or has end organ damage (NICE 2006)

  9. Measurement considerations • Techniques • No of readings • Cuffs • Home BP • Ambulatory

  10. Investigations (order of priority??) • Urine dipstix • U+E, creatinine (eGFR?) • TC + HDL • ECG

  11. Rx? • (Smoking) • (Low fat diet) • Exercise or physical activity • Low salt diet • Low alcohol • Low caffeine • Relaxation? • Types of fat?

  12. Cardiac Risk Assessments http://www.cvhealth.ed.ac.uk/othercalcs/cardiacrisk.html http://www.patient.co.uk/showdoc/40000133/ http://www.epi.bris.ac.uk/CVDethrisk/

  13. Involving patients

  14. Oh, OK then have some drugs! • < 55yrs A • > 55 or black patients C or D A+C or A+D A+C+D

  15. Summary – think carefully • Measurements • Interventions • Explaining to patients • Empowering vs disempowering patients • Use risk calculators • Non drug Rx is probably at least as effective as a whole stack of medication • Integrate your patients values into the management plan. • Don’t be bullied by QoF etc.