Excerpt

This national guideline provides recommendations and supporting evidence for the care of patients with persistent raised blood pressure but no obvious underlying disease (essential hypertension). The guideline recognises that successfully reducing blood pressure, and (more broadly) cardiovascular risk, involves a partnership and good communication between patients and healthcare professionals. Its objective is to decrease subsequent cardiovascular morbidity and mortality due to stroke and coronary heart disease.

Guidance is provided on: establishing when a patient has persistent raised blood pressure; using cardiovascular risk assessments; providing lifestyle advice; managing the use of blood pressure lowering drugs; addressing adherence; and stopping treatment. The guideline has been developed for use by the National Health Service in England and Wales. NHS healthcare professionals, patient representatives and researchers developed this guideline, incorporating comments received from referees and from an extensive national stakeholder consultation.

Contents

• Summary
  • Overview
  • Recommendation overview
  • Measuring blood pressure
  • Lifestyle interventions
  • Estimating cardiovascular risk
  • Pharmacological interventions
  • Continuing treatment
• Glossary
• Methods
  • Scope and Purpose
  • Contributors
  • Development Methods
  • Declarations
  • References
• Evidence
  • Introduction
  • Measuring blood pressure
  • Estimating cardiovascular risk
  • Lifestyle interventions
  • Pharmacological interventions
  • Continuing treatment
  • Audit points
  • Research questions
  • References
• Appendices
  • Appendix 1 Describing the results of trials
  • Appendix 2 A review of recent major guidelines
  • Appendix 3 Prescription cost analysis for cardiovascular drugs: England 2002, totals by chemical entities
  • Appendix 4 RCTs evaluating management based on home or ambulatory monitoring
  • Appendix 5 Prognostic studies comparing ambulatory, home monitoring and clinic blood pressure
  • Appendix 6 RCTs of dietary interventions
  • Appendix 7 RCTs of interventions to increase exercise
  • Appendix 8 RCTs of relaxation interventions
  • Appendix 9 RCTs of multifaceted interventions
  • Appendix 10 RCTs of interventions to reduce alcohol intake
  • Appendix 11 RCTs of interventions to increase calcium salt intake
  • Appendix 12 RCTs of interventions to increase magnesium salt intake
  • Appendix 13 RCTs of interventions to increase potassium salt intake
  • Appendix 14 RCTs of interventions to reduce sodium salt intake
  • Appendix 15 RCTs of combined salt supplements
  • Appendix 16 RCTs comparing lifestyle and drug interventions
  • Appendix 17 RCTs of pharmacological interventions
  • Appendix 18 RCTs of lifestyle interventions to support withdrawal of anti-hypertensive drugs