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Hypertension 

Key Considerations

- Up to 50% of patients do not adhere to BP treatment over time 

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- Weight and blood pressure are closely related. Losing weight generally reduces blood pressure

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- It can take a few weeks before the full effect of the blood pressure medication to take place

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- Kidney function (eGFR) tends to decline with age

    

Other considerations 

- Patients should be encouraged to have a home blood pressure monitor. Some surgeries allow patient's to loan BP monitors.  

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- Blood tests requirements depend on the medication being prescribed 

Treatment choice

 
blood pressure
Blood pressure targets
hypotension
Reviewing the patient/ Titration
 

- Check blood pressure around 3- 4 weeks after starting a new treatment or changes to a dose of an existing antihypertension 

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- If the patient's blood pressure is especially high (stage 2 or 3), you can check their BP readings sooner 

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- Clinic blood pressure can be used at first. If the patient's blood pressure is still above the target, then advise the patient to complete 4-7 days of HBPM. 

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- If the average HBPM reading is still above the target, then consider intensifying treatment (increasing the dose of current antihypertensives, or introducing a further agent)  

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HBPM counselling 

- Avoid eating, exercising, or taking medication before the reading 

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- Avoid caffeine intake at least 2 hours before the reading 

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- Ensure cuff is at heart level 

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- Sit quietly 5 minutes before taking readings 

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- Try not to move or talk whilst taking readings 

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- Measure BP around the same time each day 

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- Take 3 measurements 1-2 minutes apart 

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- 3 morning readings and 3 evening readings for 4-7 days

Monitoring
 
hypertension

- It’s good practice to perform annual cardiovascular blood tests—such as HbA1c and non-fasting lipids—for patients on antihypertensives

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- Baseline U&Es should be checked before starting ACEi/ARBs, spironolactone, or thiazide-like diuretics to monitor for any impact on kidney function

Hypertension in Diabetes/ CKD

- ACEi or ARB drugs are first line for hypertension in diabetes as they have a kidney protection effect 

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- 140/90mmHg target clinic blood pressure 

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- 130/80mmHg target for people with :

    - CKD and diabetes

    - an ACR of 70 mg/mmol or more

Sick day guidance 

- Stay hydrated and try to maintain usual calorie intake 

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- Which medications to pause: 

    - ACEi/ARBs - risk of kidney damage 

    - Diuretics - risk of dehydration 

    - NSAIDs - risk of kidney damage 

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- Medications can be restarted 24-48 hours after patient is feeling well

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Safety netting/Counselling

- Advise patient to call book an appointment or call 111  if they become hypotensive (BP reading of 90/60)

 

- If patient is also experiencing moderate/severe symptoms of hypotension they can be advised to visit A&E 

 

 - Consider titrating treatment down and performing 4-7 days of HBPM

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- Advise on symptoms of heart attack and stroke and to call 999 

FAQ's

 
What should I be looking out for when checking U&Es 

If a decline in eGFR or changes in electrolytes is seen, ensure patient was well hydrated prior to the reading and consider repeating U&Es

What time of the day should patient's take their medication? 

It is up to patient preference, however patients should try to take their medication around the same time each day 

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