Managing hypertension and meeting targets

Abstract

T he ultimate goal of identifying and treating patients with hypertension is to reduce the potential morbidity and premature mortality associated with the condition. Despite constantly updated evidence-based guidelines and a wide choice of potent, effective and usually well-tolerated antihypertensive drugs, only 37 per cent of patients have their blood pressure (BP) adequately controlled.1 While perfect control does not prevent cardiovascular disease (CVD), compared to normotensive subjects there is a 37 per cent greater lifetime risk of developing CVD in those with a BP >140/90mmHg, which will develop on average five years earlier. 2The current BP targets are not under dispute, but to achieve greater accuracy you need to: have a clear understanding of the long-term life and death implications of failure; concentrate on achieving the goal; achieve a balance of effort (neither too quick nor too slow) and know when to call it a day; focus on the details; and remain personally responsible for the equipment and methods you use. There is no big secret to success; it results from a combination of good theoretical and practical preparation, experience, good equipment and methodology, excellent teamwork, continually learning from others and not giving in until the best possible outcome has been achieved. Accurate BP assessment is the basis of diagnosis and subsequent monitoringThe NICE guideline for hypertension (CG127) defines it as a clinic BP reading of ≥140/90mmHg combined with an ambulatory daytime or home BP average of ≥135/85mmHg (for those patients aged 80 years and over, the threshold clinic BP for diagnosis is ≥160/100mmHg with a home or ambulatory daytime mean of ≥150/95mmHg Despite constantly updated guidelines and a wide choice of drugs for hypertension only 37 per cent of patients have their blood pressure (BP) adequately controlled. This article give practical tips on how best to achieve the targets for BP control using current guidelines. SPL