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Hypertension - Optimising therapy

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Hypertension - Optimising therapy

Hypertension is the most prevalent single cardiovascular risk factor globally and possibly the most damaging contributing risk factor for stroke, heart failure and renal disease.1,2 NICE guidance3 provides clarity on diagnosis, and a stepped approach on management for both those with and without cardiovascular disease (CVD). However, despite this guidance, hypertension remains sub optimally managed in the UK, putting patients at increased risk of CVD. The reasons for inadequate control may be many, ranging from poor diagnosis, non-adherence to medical therapy, and inappropriate lifestyle behaviour and sub optimisation of drug therapy.

This resource, consisting of five assessment questions at advanced level, tests your understanding of the drug treatments for hypertension, and the reasons for regular monitoring. Complete the resource, including reading the featured articles and undertaking some or all of the activities, to obtain a certificate for one hour of continuing professional development to include in your annual portfolio.

Aims and objectives

On completion of this resource you should have an understanding of:

  • Recommended first, second and third line drug therapy treatment for hypertension
  • The differences in medication for those people from African or Caribbean family origin
  • The complexities of prescribing medication when someone has comorbidities
  • The implications of dual or triple therapy for patients in terms of concordance
  • The need for regular review and monitoring of renal function

References

1. Rothwell PM et al: Prognostic significance of visit to visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 2010; 375 (9718):895-905.

2. Schofield P et al: Ethnic differences in blood pressure monitoring and control in south east London. British Journal of General Practice 2011; 61 (585):190-196.

3. NICE. Hypertension: clinical management of primary hypertension in adults: Clinical guideline 127. 2011; http://www.nice.org.uk/CG127

Practice Nurse featured article

Hypertension for the practice nurse Dr Mary Lowth

Recommended reading

Davies M et al, for UK National screening Committee, The updated handbook for vascular risk assessment, risk reduction and risk management, 2012 http://www.healthcheck.nhs.uk/commissioners_and_healthcare_professionals/national_guidance/cardiovascular_risk_assessment/

The European guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal 2012: 1635-1701

Joint British Societies guidelines on prevention of cardiovascular disease in clinical practice. (JBS3),2014 http://heart.bmj.com/content/100/Suppl_2/ii1.full