Hypertension

Last night our local cardiologist reviewed the aetiology, diagnosis and management of hypertension, touching on the role of ambulatory monitoring. What did I learn?

• Whilst beta blockers have a role in people with heart disease, they should be avoid as first line antihypertensives because of their potential for causing diabetes. They are quite good at reducing the risk of heart disease but less effective at reducing the risk of stroke.
• Bisoprolol is probably a better choice beta blocker compared to atenolol because it gives better 24 hour cover.
• ACEI's and ARB's can be combined in resistent hypertension - sometimes to good effect.
• Ambulatory monitoring remains a useful adjunct in diagnosis of white coat hypertension and in monitoring those people who are resistent to treatment. Rule of thumb at 10mmHg to 24 hr mean systolic and 5mmHg to 24 hr mean diastolic. In people with BP's of 130-139/85-90 consider annual repeat.
• Statins have significant effect on reducing risk of CVD in people with hypertension - perhaps they should all have treatment? ASCOT trial seems to be best evidence to date on this.
• Diuretics remain a good first choice agent in over 55 yr olds and people of Afro-Carribean origin.
• NICE and BHS are going to issue a consensus statement in July 06 - must watch out for that!

Shared Care Forum - May 2006

Messages from the Calderdale and Kirklees shared care forum:

1. Tetanus status needs checking on all drug users, immunise as appropriate
2. Consider SBE with low grade fever in injecting drug users
3. Pain relief in substitute treatment - more difficult with buprenorphine, consider split doses, consider raised doses, consider switch to methadone. In methadone patients consider split doses with increased total dose and consider additional analgaesic.