The full NHSGGC Hypertension guideline is currently under review and once updated will be available on StaffNet, Clinical Guideline Electronic Resource Directory and search in Cardiovascular system.
Hypertension is usually asymptomatic, often going unnoticed or untreated. It increases the risk of coronary heart disease, heart failure, stroke and renal disease. Only 25% of patients will achieve satisfactory control of blood pressure with one drug alone. Many will require drugs from 3 different groups. Compliance with medication is poor, as in many long-term conditions, but particularly when the condition is asymptomatic. Emergency or urgent situations regarding hypertension are rare, but when they present must be treated immediately.
These include encephalopathy, aortic dissection, phaeochromocytoma, left ventricular dysfunction with severe hypertension or eclampsia or recreational drug-induced severe hypertension which can lead to MI. These need rapid but not immediate or precipitous treatment. Seek immediate on-call consultant advice.
These include severe hypertension with Grade 3 or 4 retinopathy and headache but no other features, which need around a 25% reduction over 6 hours or so. Seek immediate on-call consultant advice.
Most hypertension is managed well by GPs and that should be the default. It is part of the Quality and Outcomes Framework of the nGMS contract. Only when there is a problem in achieving targets after trying at least 3 drug groups in combination, unusual variability in blood pressure measurement, certain other co-morbidities such as AF or heart failure or an obvious cause of the hypertension (e.g. renal failure), is expert care required.
Non-drug treatment (management of obesity, moderating alcohol intake, reduction in salt intake, and increased exercise) should be instituted in all patients, where relevant. All other cardiovascular risk factors should be addressed e.g. smoking and diet. Compliance issues require to be addressed.
It is important that return outpatient appointments are not offered unnecessarily and that outpatient recommendations for prescribing are in line with the agreed guidelines.