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/cardia crisk.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. Dont be bullied by QoF etc.