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Best practices for managing hypertension

Best practices for managing hypertension

Beta-blockers dose adjustments may be required for patients with Isotonic drink comparisons dysfunction. Do you smoke? Department Best practices for managing hypertension Hypertensionn. Molar mwnaging MRI: Is gadolinium safe for people with kidney problems? adult population, have HTN. elderly patients or those already close to their blood pressure target. There are currently no recommendations for applying intensive targets in primary care.

Best practices for managing hypertension -

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Audits View all audits. CME Quizzes Do Quizzes. Peer Group Discussions View all discussions. About us FAQ Contact us Terms of use. Hello there! please login to access my bpac Username. Remember me. Cardiovascular system Nephrology. Hypertension in adults: the silent killer Hypertension is a common finding among patients in primary care; ideal pharmacological treatment, however, continues to be debated.

Please login to save this article. Log in. Hypertension is a continuum requiring regular review Diagnosing hypertension The options for managing hypertension Consider individualised blood pressure targets Intensifying treatment over the short-term Longer-term follow-up and monitoring Other resources B-QuiCK summary Hypertension quiz Peer group discussion.

Published: 27 January Updated: 15 August What's changed? This is a revision of a previously published article. many people should be initiated on two low-dose antihypertensives rather than starting with a single antihypertensive and increasing the dose Discussion on individualising blood pressure targets Review of the conflicting evidence for night-time versus morning antihypertensive dosing.

Hypertension is a continuum requiring regular review Hypertension is a common incidental clinical finding in primary care. Diagnosing hypertension Treatment for hypertension often involves lifelong exposure to multiple medicines and their potential adverse effects.

Confirming elevated blood pressure To achieve a more accurate assessment, it is recommended that two or more blood pressure measurements are taken, at least two minutes apart.

Secondary causes of hypertension include: 5, 6, 9 High alcohol intake, e. amphetamine or cocaine use Certain medicines, e. oral contraceptives and corticosteroids, non-steroidal anti-inflammatory drugs NSAIDs , ciclosporin and decongestants, e. phenylephrine Obstructive sleep apnoea Aortic coarctation, suggested by a diminished or delayed femoral pulse and low or unobtainable blood pressure in the legs, or abnormal differences in the upper and lower extremity arterial pulses Renovascular or primary renal disease Renal parenchymal disease, including glomerulonephritis, suggested by a history of urinary tract infection or obstruction, haematuria, analgesic misuse or a family history of polycystic kidney disease Endocrine disorders, e.

The options for managing hypertension Lifestyle modifications are important for all patients Healthy lifestyle advice should be given to all patients with persistently elevated blood pressure measurements and reinforced if a diagnosis of hypertension is ultimately made.

International guidelines are increasingly recommending the dietary approaches to stop hypertension DASH diet. Increasing physical activity, e. regular moderate intensity exercise such as walking for at least 30 minutes per day, five days per week, if possible.

However, any increase in exercise engagement is likely beneficial. Despite previously being regarded as a second-line option after ACE inhibitors, ARBs are now considered to provide comparable benefit for treating patients with hypertension and are often better tolerated.

Calcium channel blockers Thiazide and thiazide-like diuretics Practice point: ACE inhibitors and ARBs should generally not be prescribed in combination unless under specialist supervision primarily due to the increased risk of renal impairment and hyperkalaemia. aspx Table 1. Read more Voluntary recalls of the combination antihypertensive Accuretic quinapril with hydrochlorothiazide have been occurring worldwide since March, , after the supplier Pfizer advised that batches had been contaminated with nitrosamines.

diltiazem, verapamil Beta-blockers in patients with uncontrolled heart failure Acute myocardial infarction Beta-blockers without intrinsic sympathomimetic activity, e. carvedilol ACE inhibitors or ARBs No specific cautions Atrial fibrillation Beta-blockers Rate limiting calcium channel blocker, e.

diltiazem ACE inhibitors or ARBs No specific cautions Angina Beta-blockers Calcium channel blockers ACE inhibitors or ARBs No specific cautions Cerebrovascular disease, i.

Age alone is not a reason to dial back treatment The risk of falls or orthostatic hypotension are often cited as concerns when considering blood pressure management in elderly patients e. Intensifying treatment over the short-term Patients starting antihypertensive treatment should initially be reviewed at least every four-to-six weeks to assess the efficacy of their regimen.

If a target is not achieved, the next step depends on how well the patient tolerates treatment and how close they are to their objective Figure 2 : 5 If the patient is close to their target blood pressure and the antihypertensive medicine s are well tolerated: increase the dose of their existing antihypertensive s and re-emphasise the importance of lifestyle changes If the patient is not close to their target blood pressure and adherence is not an issue: add an additional antihypertensive and re-emphasise the importance of lifestyle changes, e.

Spironolactone may be particularly beneficial as many patients with resistant hypertension have high aldosterone levels even if they do not have clinically apparent primary hyperaldosteronism ; spironolactone impairs aldosterone binding to mineralocorticoid receptors which limits vascular resistance.

Spironolactone should be introduced cautiously with ongoing monitoring of serum potassium and creatinine. Beta-blocker — no longer considered a first-line antihypertensive for patients with uncomplicated hypertension but may be useful if indicated for a co-morbidity, e.

atrial fibrillation. All beta-blockers have comparable blood pressure lowering effects. Alpha-blocker e. doxazosin — beneficial for lowering blood pressure but should be used with caution in females as these medicines may sometimes cause urinary stress incontinence and loss of bladder control.

A scenario where alpha-blockers may be considered is in males with hypertension who also have benign prostatic hyperplasia to alleviate nocturia. Novel techniques for treating patients with resistant hypertension A range of novel procedure- and device-based strategies have been investigated for the management of resistant hypertension.

Longer-term follow-up and monitoring Once a blood pressure target has been achieved, continued long-term follow-up is important to ensure levels are maintained, and to reinforce the importance of medicine adherence and a healthy lifestyle.

Night-time antihypertensive dosing: does it reduce the risk of CVD events? Update: European Society of Hypertension ESH guidelines now available on the management of arterial hypertension New ESH hypertension guidelines have been released, providing clinicians with further direction when treating patients with hypertension.

Acknowledgement Thank you to Dr. Article supported by the South Link Education Trust References National Institute for Health and Care Excellence NICE. Hypertension in adults: diagnosis and management. Oparil S, Acelajado MC, Bakris GL, et al.

Nat Rev Dis Primers ; McGraw-Hill Australia Pty Ltd Williams B, Mancia G, Spiering W, et al. European Heart Journal ;— Unger T, Borghi C, Charchar F, et al. Hypertension ;— Ministry of Health. Cardiovascular disease risk assessment and management for primary care. pdf Accessed Jan, McLean RM, Williams S, Mann JI, et al.

N Z Med J ;— Ministry of Health MOH. National Heart Foundation of Australia. Guideline for the diagnosis and management of hypertension in adults. Cheung CY, Biousse V, Keane PA, et al.

Hypertensive eye disease. Recent advances in managing primary hypertension. Home Health Topics High Blood Pressure Changes You Can Make to Manage High Blood Pressure.

Know your numbers. By adopting a heart-healthy lifestyle, you can: Reduce high blood pressure. Prevent or delay the development of high blood pressure. Enhance the effectiveness of blood pressure medications.

Lower your risk of heart attack , stroke , heart failure , kidney damage , vision loss and sexual dysfunction. HBP Resources Questions to Ask Your Doctor Interactive Questions to Ask Your Doctor PDF Animation Library Track Your Blood Pressure PDF How to Measure Your Blood Pressure PDF Find High Blood Pressure Tools and Resources.

Last Reviewed: Jun 1, Get the Research App. Hablemas sobre presión arterial. Play without Auto-Play Play Video Text. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.

search close. PREV Mar 15, NEXT. From the AFP Editors. What is the optimal BP target for antihypertensive therapy in adults? BP Measurement and Out-of-Office Monitoring. White Coat and Masked Hypertension. Treatment Goals.

In those with systolic BP of to mm Hg within six hours of the event, immediate lowering of systolic BP to less than mm Hg is potentially harmful.

Evidence rating system used? Systematic literature search described? Guideline developed by participants without relevant financial ties to industry?

Recommendations based on patient-oriented outcomes? This series is coordinated by Michael J. Arnold, MD, associate medical editor. Continue Reading. More in AFP. More in Pubmed. Copyright © by the American Academy of Family Physicians. Copyright © American Academy of Family Physicians.

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The jypertension are key points to remember from the Guideline for the Prevention, Detection, Best practices for managing hypertension, manxging Management of Practuces Blood Pressure in Adults:. Keywords: Adrenergic beta-Antagonists, AHA17, AHA Annual Scientific Sessions, Antihypertensive Bdst, Aortic Diseases, Atherosclerosis, Enhance insulin sensitivity and reduce insulin spikes Fibrillation, Blood Pressure, Blood Pressure Monitoring, Ambulatory, Body Bypertension Changes, Cerebral Hemorrhage, Cerebrovascular Hypertensioon, Coronary Artery Disease, Diabetes Mellitus, Diagnostic Best practices for managing hypertension, Diagnostic Manaving, Cardiovascular, Diet, Electronic Health Records, BBest, Geriatrics, Heart Failure, Heart Valve Diseases, Hypertension, Life Style, Mass Screening, Medical History Taking, Metabolic Syndrome, Patient Compliance, Patient Care Team, Perioperative Period, Peripheral Arterial Disease, Peripheral Vascular Diseases, Pregnancy, Primary Prevention, Quality of Health Care, Renal Insufficiency, Chronic, Risk Assessment, Risk Factors, Risk Reduction Behavior, Secondary Prevention, Self Care, Angina, Stable, Stroke, Telemedicine, Therapeutics, Transplantation. The guideline is a comprehensive guideline incorporating new information from studies regarding blood pressure BP -related risk of cardiovascular disease CVDambulatory BP monitoring ABPMhome BP monitoring HBPMBP thresholds to initiate antihypertensive drug treatment, BP goals of treatment, strategies to improve hypertension treatment and control, and various other important issues. It is critical that health care providers follow the standards for accurate BP measurement. BP should be categorized as normal, elevated, or stages 1 or 2 hypertension to prevent and treat high BP. Mayo Clinic practicees Best practices for managing hypertension in Arizona, Best practices for managing hypertension and Minnesota and hyperteneion Mayo Clinic Type diabetes medications side effects System locations. By making these 10 lifestyle practice, you can lower your blood pressure and reduce your risk of heart disease. If you have high blood pressure, you may wonder if medication is necessary to bring the numbers down. But lifestyle plays a vital role in treating high blood pressure. Controlling blood pressure with a healthy lifestyle might prevent, delay or reduce the need for medication. Blood pressure often increases as weight increases.

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