Presentation on theme: "Hypertension Nick Price 22.8.07. Aim Consider the application of evidence based practice in the management of hypertension in primary care. EBP – defined."— Presentation transcript:
Hypertension Nick Price
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)
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
So what is hypertension all about?
Disease Orientated Outcomes
Patient Orientated Outcomes
Others Orientated Outcomes GPs Practice nurses PCTs Secondary Care Patient groups (e.g. BHF) Professional groups (e.g. BHS) Drug Companies Government
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)
Measurement considerations Techniques No of readings Cuffs Home BP Ambulatory
Rx? (Smoking) (Low fat diet) Exercise or physical activity Low salt diet Low alcohol Low caffeine Relaxation? Types of fat?
Cardiac Risk Assessments crisk.html
Oh, OK then have some drugs! < 55yrs A > 55 or black patients C or D A+C or A+D A+C+D
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.