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Hypertension

  

Stage 1 hypertension: Clinic blood pressure is 140/90 mmHg or higher and subsequent ambulatory blood pressure monitoring (ABPM) daytime average or home blood pressure monitoring (HBPM) average blood pressure is 135/85 mmHg or higher. Stage 2 hypertension: Clinic blood pressure is 160/100 mmHg or higher and subsequent ABPM daytime average or HBPM average blood pressure is 150/95 mmHg or higher. Severe hypertension: Clinic systolic blood pressure is 180 mmHg or higher or clinic diastolic blood pressure is 110 mmHg or higher.


Hypertension Service

There are two hypertension clinics each week at UHCW and one clinic a month at Rugby St Cross Hospital

Provides expert advice on difficult hypertension problems:

  • Adverse effects of treatment
  • Management of blood pressure in complex co-morbidity
  • Investigations of suspected secondary hypertension and related issues
  • White-coat, masked and resistant/refractory hypertension
  • Rarer conditions of blood pressure dysregulation, including autonomic dysfunction and Addison’s disease, often associated with ‘low’ blood pressure.
  • Secondary causes of hypertension or present around the time of acute coronary syndromes, acute stroke syndromes and other serious unrecognised co-morbidity.
  • Pregnant women with hypertension
  • Hypertensive young patients of paediatric age.

Advice & Guidance is provided via e-Referral Service for queries that may not require a referral (see criteria later).

NHS E-Referral. The clinics are listed as SPECIALITY: Cardiology – CLINIC TYPE: Hypertension – SERVICE: Cardiovascular Risk Hypertension – University Hospital Cov-RKB or Rugby St Cross-RKB.

NB: Please make sure you identify the right clinic type under Cardiology menu as Hypertension, not General Cardiology.

Please ensure the following:

1) That hypertension is confirmed on at least two separate occasions and that white coat hypertension is ruled out in Primary Care with 24h ABPM if available (24h ABPM may be initiated after specialist assessment if indicated).

If 24h Ambulatory BP Monitoring (ABPM) is not available in primary care, use standardised Home BP Monitoring (HBPM) over 7 days (see NICE protocol).

2) Routine investigations including U+Es; fasting glucose; lipid profile; LFTs; TFTs; FBC; uric acid; ECG; US kidneys; urine dipstick (preferably urinary albumin : creatinine ratio ACR).

3) Stage 3 Hypertension should be treated initially according to NICE Guidelines and referred immediately.

4) Stage 1 & 2 Hypertension should have treatment initiated according to NICE Guidelines* and titrated up to Step 3 BEFORE referral to the Specialist clinic (*do not use step 2 combinations of ACE-I / ARBs with beta-blockers, or diuretic with alpha-blockers; do not use moxonidine, renin-inhibitors, loop-diuretics or hydralazine for routine BP management).

5) Exceptions to Point 4 above are:

  • Recurrent hypokalaemia NOT on diuretic;
  • Recurrent intermittent high BP (equivalent to Stage 3) with at least TWO symptoms of hot flushes and/or severe headaches and/or palpitations and/or sweating attacks and/or recurrent chest pains;
  • Severe target organ damage (e.g. CKD5, severe LVH, recurrent TIAs, proteinuria, etc.)
  • Resistant hypertension to Step 3 management compliant with NICE Guidelines*
  • (*do not use step 2 combinations of ACE-I / ARBs with beta-blockers, or diuretic with alpha-blockers; and do not use moxonidine, renin-inhibitors, loop-diuretics or hydralazine for routine BP management)
  • Multiple drug reactions (please document)

6) If Stage 1 or Stage 2 Hypertension and younger than 40 years of age, refer if additional concerns are present: for instance, target organ damage, signs suggestive of secondary hypertension (hypokalaemia, symptoms consistent with phaeo, resistance to Step 3 management), other CV complications or multi-morbidity.

7) If in doubt, before referral use  Advice & Guidance Service.

This is a list for guidance only and I am open to discussions with individual GPs regarding concerns about individual patients who may not fall under these categories.

Please either call (through my secretary Mrs Pam Gould on 02476 965768) or send a letter through Advice & Guidance.

 

 

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