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Management of hypertension: summary of NICE guidance

BMJ, 2011-08, Vol.343 (7821), p.474-476 [Peer Reviewed Journal]

BMJ Publishing Group Ltd 2011 ;Copyright: 2011 © BMJ Publishing Group Ltd 2011 ;ISSN: 0959-8138 ;ISSN: 0959-8146 ;EISSN: 1468-5833 ;EISSN: 1756-1833 ;DOI: 10.1136/bmj.d4891 ;PMID: 21868454 ;CODEN: BMJOAE

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Title:
Management of hypertension: summary of NICE guidance
Author: Krause, Taryn ; Lovibond, Kate ; Caulfield, Mark ; McCormack, Terry ; Williams, Bryan
Subjects: Adult ; African Continental Ancestry Group ; Aged ; Aged, 80 and over ; Ambulatory blood pressure monitoring ; Angiotensin converting enzyme inhibitors ; Angiotensin Receptor Antagonists - therapeutic use ; Angiotensin-Converting Enzyme Inhibitors - therapeutic use ; Antihypertensive Agents - therapeutic use ; Antihypertensives ; Bias ; Blood pressure ; Blood Pressure Monitoring, Ambulatory ; Calcium channel blockers ; Calcium Channel Blockers - therapeutic use ; Cardiovascular disease ; Cardiovascular diseases ; Case management ; Cost-Benefit Analysis ; Diabetes ; Diuretics ; Dosage ; Drug Therapy, Combination ; Female ; Health care ; Health education ; Humans ; Hypertension ; Hypertension - diagnosis ; Hypertension - drug therapy ; Kidney diseases ; Male ; Middle Aged ; PRACTICE ; Practice Guidelines as Topic ; Primary care ; Quality ; Recommendations ; Risk Assessment ; Substance abuse treatment ; United Kingdom
Is Part Of: BMJ, 2011-08, Vol.343 (7821), p.474-476
Description: (Updated recommendation) [Based on systematic reviews and meta-analyses of low quality observational and low to high quality randomised controlled trials; prognostic studies determined to be at low risk of bias; and a blood pressure equivalence study of low quality] Offer antihypertensive drug treatment to people of any age with stage 2 hypertension (an average ambulatory or home blood pressure of >=150/95 mm Hg; a clinic blood pressure >=160/100 mm Hg) irrespective of the presence of target organ damage, cardiovascular disease, renal disease, or the 10 year risk of cardiovascular disease. (Updated recommendation) [Based on moderate to very low quality evidence from randomised controlled trials and on the experience and opinion of the GDG] Step 4 (Resistant hypertension) If clinic blood pressure remains higher than 140/90 mm Hg after treatment with the optimal or best tolerated doses of the drug combination mentioned in step 3 (an ACE inhibitor or an ARB combined with a calcium channel blocker and a diuretic), regard this as resistant hypertension, and consider adding a fourth antihypertensive drug and/or seeking expert advice. (Updated recommendation) [Based on systematic reviews of very low to moderate quality randomised controlled trials, and cost effectiveness evidence] For people identified as having a "white coat effect"-that is, a discrepancy of more than 20/10 mm Hg between clinic and average daytime ambulatory blood pressure or average home blood pressure measurements at the time of diagnosis-consider ambulatory or home blood pressure monitoring as an adjunct to clinic blood pressure measurements to monitor the response to antihypertensive treatment with lifestyle modification or drugs. (Updated recommendation) [Based on a systematic review and meta-analysis that included moderate and high quality randomised controlled trials] Overcoming barriers The recommendation that ambulatory blood pressure rather than clinic blood pressure measurements should be used to confirm the diagnosis of hypertension will have a profound impact on patient care by reducing the number who are incorrectly labelled as hypertensive and thus inappropriately prescribed antihypertensive treatment.
Publisher: England: British Medical Journal Publishing Group
Language: English
Identifier: ISSN: 0959-8138
ISSN: 0959-8146
EISSN: 1468-5833
EISSN: 1756-1833
DOI: 10.1136/bmj.d4891
PMID: 21868454
CODEN: BMJOAE
Source: MEDLINE
Alma/SFX Local Collection
ProQuest Central

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Management of hypertension: summary of NICE guidance

BMJ Publishing Group Ltd 2011 ;Copyright: 2011 © BMJ Publishing Group Ltd 2011 ;ISSN: 0959-8138 ;ISSN: 0959-8146 ;EISSN: 1468-5833 ;EISSN: 1756-1833 ;DOI: 10.1136/bmj.d4891 ;PMID: 21868454 ;CODEN: BMJOAE

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