Ep 58 – Hypertension management

After smoking and diet, hypertension is the biggest risk factor in the UK for premature death and disability. One in four people have hypertension in the UK, with around one in three treated to target. In this episode, Dr Roger Henderson gives an overview of the management of hypertension, covering its definition, risk factors, lifestyle management, investigations and medical treatments, including those recommended in the latest NICE guidelines.

Key references:

1. NICE. Hypertension in adults: diagnosis and management. NG136. 2019.
2. BMJ. Management of hypertension: summary of NICE guidance. 2019.
3. BMJ Best Practive. Essential hypertension. 2022.
4. GPnotebook. Conn's syndrome. 2022.

Key take-home points:

• After smoking and diet, hypertension is the biggest risk factor in the UK for premature death and disability.
• Around 90% of cases are primary – or essential – hypertension, where no obvious cause is found.
• The remainder of cases (secondary hypertension) are usually linked to endocrine problems, renal disease or pregnancy.
• Non-modifiable risks include getting older, gender, a family history of hypertension and ethnicity.
• Modifiable risks include obesity, smoking, alcohol, a sedentary lifestyle and too much salt in the diet.
• Stage 1 hypertension is classified as a blood pressure greater than 140/90 mmHg, stage 2 is greater than 160/100 mmHg and stage 3 is greater than 180/120 mmHg
• The diagnosis is confirmed if blood pressure taken in surgery is repeatedly greater than 140/90 mmHg and the average ambulatory blood pressure readings are 135/85 mmHg or higher.
• Consider treating individuals under the age of 60 with stage 1 hypertension and an estimated cardiovascular disease risk greater than 10%.
• Offer treatment to adults of any age with stage 2 hypertension.
• If type 2 diabetes is present, or if a person is under the age of 55 and is not of black African or African-Caribbean family origin, start treatment with an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), adding in a calcium channel blocker or thiazide-like diuretic if required.
• For hypertension without type 2 diabetes, where the individual is aged 55 or over or is of black African or African-Caribbean family origin, start treatment with a calcium channel blocker, adding in an ACE inhibitor, an ARB or a thiazide-like diuretic.
• The NICE guidelines provide further advice on treatment scenarios.
• Seek expert advice if blood pressure remains uncontrolled on optimal tolerated doses of four drugs.