Treatment Flow for Hypertension (NICE Guidelines)

Question 1

According to the NICE guidelines what what blood pressure is an indicator to clinicians to start treatment immediately?

Answer 1

• SBP >180 mmHg

- stage 3 hypertension

Question 2

According to the NICE guidelines what what blood pressure requires 24 hour monitoring to confirm stage 2 hypertension (due to which coat syndrome) prior to starting treatment?

Answer 2

• BP >160/100 mmHg

- stage 2 hypertension

Question 3

According to the NICE guidelines in a patient with end stage organ damage or diabetic, what blood pressure requires treatment to begin?

Answer 3

• BP > 140/90 mmHg

- stage 1 hypertension

Question 4

If a patient presents with a high blood pressure, what is the first thing clinicians will tell them to do?

Answer 4

• change lifestyle
• lose weight
• ⬇️ salt
• ⬇️ alcohol
• increase exercise/physical activity

Question 5

Using the ABC system below, what would be the first line of treatment for hypertension for a caucasian individual under 55 years of age based on the NICE guidelines?

A = ACE-I or AR2B
C = Calcium channel blocker
D = thiazide diuretic

Answer 5

• A
• Ramipril = ACE-I
• Losartan = AR2B

Question 6

Using the ABC system below, what would be the second line of treatment for hypertension for any patient based on the NICE guidelines?

A = ACE-I or AR2B
C = Calcium channel blocker
D = thiazide diuretic

Answer 6

• A + C or A + D

Question 7

Using the ABC system below, what would be the third line of treatment for hypertension for any patient based on the NICE guidelines?

A = ACE-I or AR2B
C = Calcium channel blocker
D = thiazide diuretic

Answer 7

• A + B + C

Question 8

Using the ABC system below, what would be the first line of treatment for hypertension for a black or >55 years of age patient based on the NICE guidelines?

A = ACE-I or AR2B
C = Calcium channel blocker
D = thiazide diuretic

Answer 8

• C or D

Question 9

Why are >55 year olds and black patients not prescribed an ACE-I or AR2B as the first line of treatment for hypertension?

Answer 9

• > 55/year = more side effects of ACE-I or AR2B

- black = less sensitive to ACE-I or AR2B

Question 10

Based on the NICE guidelines when treating patients for hypertension, what can clinicians do if the combinations of ACE-I, AR2B, Calcium channel blockers and thiazide diuretic are insufficient?

Answer 10

• add in alpha or beta antagonist
• add in additional diuretic
• prescribe based on other co-morbidities

Question 11

What are the NICE target guidelines for the treatment of hypertension?

Answer 11

• <80 years = <140/90 mmHg
• > 80 years = <150/90 mmHg
• patient with diabetes = <135/85 mmHg