Authors' objectives:

This report provides guidelines on the management of hypertension in adults in primary care.

Authors' recommendations: The following have been identified as priorities for implementation. Measuring blood pressure - To identify hypertension (persistent raised blood pressure above 140/90 mmHg), ask the patient to return for at least two subsequent clinics where their blood pressure is assessed from two readings using the best conditions available. - Routine use of automated ambulatory blood pressure monitoring or home monitoring devices in primary care is not currently recommended because their value has not been adequately established; appropriate use in primary care remains an issue for further research. Lifestyle interventions - Lifestyle advice should be offered initially and then periodically to patients undergoing assessment or treatment for hypertension. Cardiovascular risk - If raised blood pressure persists and the patient does not have established cardiovascular disease, discuss with them the need to formally assess their cardiovascular risk. Tests may help identify diabetes, evidence of hypertensive damage to the heart and kidneys, and secondary causes of hypertension such as kidney disease. - Consider the need for specialist investigation of patients with signs and symptoms suggesting a secondary cause of hypertension. Accelerated (malignant) hypertension and suspected pheochromocytoma require immediate referral. Pharmacological interventions - Drug therapy reduces the risk of cardiovascular disease and death. Offer drug therapy to: - patients with persistent high blood pressure of 160/100 mmHg or more - patients at raised cardiovascular risk (10-year risk of CHD 15% or CVD 20% or existing cardiovascular disease or target organ damage) with persistent blood pressure of more than 140/90 mmHg. - Drug therapy should normally begin with a low-dose thiazide-type diuretic. If necessary, second line add a beta-blocker unless patient is at raised risk of new-onset diabetes, in which case add an angiotensin converting enzyme (ACE)-inhibitor. Third line, add a dihydropyridine calcium-channel blocker. Continuing treatment - Provide an annual review of care to monitor blood pressure, provide patients with support and discuss their lifestyle, symptoms and medication. - Patients may become motivated to make lifestyle changes and want to stop using antihypertensive drugs. If at low cardiovascular risk and with well controlled blood pressure, these patients should be offered a trial reduction or withdrawal of therapy with appropriate lifestyle guidance and ongoing review.

Authors' methods: Clinical guideline

Project Status: Completed

URL for project: http://www.nice.org.uk/page.aspx?o=217968

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: National Institute for Clinical Excellence

Contact Address: MidCity Place, 71 High Holborn, London WC1V 6NA, UK. Tel: +44 020 7067 5800; Fax: +44 020 7067 5801

Contact Name: nice@nice.nhs.uk

Contact Email: nice@nice.nhs.uk

Copyright: National Institute for Clinical Excellence (NICE)