Blood pressure is a measurement of the force against the walls of your arteries as your heart pumps blood through your body. Hypertension is another term used to describe high blood pressure. This common condition increases the risk for heart disease and stroke, two leading causes of death for Americans. High blood pressure contributed to more than 362,895 deaths in the United States during 2010. Approximately 67 million persons in the United States have high blood pressure, and only half of those have their condition under control. An estimated 46,000 deaths could be avoided annually if 70% of patients with high blood pressure were treated according to published guidelines (Patel, ...view middle of the document...
The guidance brought important changes to both the diagnosis and also the management of hypertension. One major new recommendation is that diagnoses of high blood pressure should be confirmed by giving patients a test called 24-hour ambulatory blood pressure monitoring (ABPM). The test involves carrying a mobile blood pressure monitor that records several blood pressure measurements throughout the day and night. According to NICE this test can give a better diagnosis than simply relying on measurements in a clinical setting (Williams, 2013).
For HBPM, the patient needs to have access to a validated BP machine that has been calibrated. The patient takes BP readings morning and evening for seven days and records the results. For every BP recording, two consecutive measurements should be taken at least one minute apart with the person seated. The first day’s results should be discarded and an average of the results of all of the other readings should be used to assess the presence or absence of high BP. For ABPM, as well as, HBPM, the threshold for diagnosis of hypertension is a BP greater than or equal to 135/85 mmHg (Williams, 2013).
All patients should be offered lifestyle recommendations to manage cardiovascular risk factors, as well as, smoking cessation. Dietary modification, including reducing salt intake, increased exercise, weight loss, and alcohol moderation will considerably lower the blood pressure. In patients with stage 1 hypertension and low or moderate calculated CV risk (less than 20 % over 10 years), non-pharmacological management of
hypertension is the recommended option (Patel, Datu, Roman, Barton, Ritchey, Wall, & Loustalot; 2014).
In the past, there was an inclination to initiate drug therapy in all patients with hypertension. This was driven by the pressure of attaining clinical target goals, however this approach is not evidence based. Drug therapy now should be initiated in consistence with NICE guidelines. Essentially, drug therapy should be considered for all patients with stage 2 hypertension, but only for selected high risk patients with stage 1 hypertension. A NICE treatment protocol outlines medication options for the treatment of hypertension. NICE recommends completely different treatment choices at step 1, primarily based on age and ethnicity. Angiotensin-converting enzyme inhibitors (ACEIs) or low-price angiotensin-II receptor blockers (ARBs) ought to be used first in younger patients (age < 55 years) and at step 2, in combination with a calcium channel blocker, in all patients. Finally, there's a clear recommendation from NICE that ACEI and ARB therapy should not be combined for the treatment of hypertension, as there's very little evidence of improved BP lowering effect, but a clear increase in the risk of adverse effects. A...