text: Diagnosing and managing hypertension can help minimise the risk of cardiovascular disease In the last article of the year in our Learning points series Candy Norris refreshes our knowledge on the As a major modifiable contributory factor in cardiovascular disease, the management of high blood pressure is an important way minimise this risk. However, to best achieve pressure targets in different patient groups not do regular exercise because of pressure Latanoprost 1 drop both eyes at night.
  through participation and to this endquestions have been included throughout this article that will help you think about to spironolactone, metformin, co-codamol, reading through the case study andassociated questions — which you are In view of his renal impairment and raised microalbuminuria/creatinine ratio of 7,what would be a target blood pressure for ˿ understand the different blood pressure this patient and what guidance is this based in their Clinical Guideline H (October 2002)1 for people with diabetes is <140/80 guidance is taken from the Chronic kidney disease in adults: UK guidelines (March above: Although patients might not feel anxious
  pharmacist-led hypertension clinic held in about having their blood pressure measured, some patients do experience a significant rise in blood albuminuria or proteinuria and for those with intensive control of his hypertension. He pressure simply because they are attending a total proteinuria of >1g per day the target clinic. This ‘white coat’ hypertension is sometimes incorrectly interpreted as genuine hypertension. mended for this patient is <130/80mmHg.
  thought to have raised blood pressure. This that dependence on drug therapy alone will result in prolonged drug therapy for a large could suggest the possibility of coarctation This patient needs to address his obesity cardiological procedures, such as cardiac problem and lack of exercise. Unfortunately, these two lifestyle factors often go hand-in- hand, and because he is also taking insulin, starting a weight loss programme couldseem to be an uphill struggle.
  Why would this patient be at risk of ‘white highlighted as a key factor in hypertension,4 The patient could be at risk of white coat istockphoto be that there are some gentle exercises that secondary care clinic and, therefore, visiting outpatients at hospital. Although patients smoker but does drink some alcohol, which above: Blood pressure readings should be made in
  both arms with the patient seated at the initial assessment. This is important to check whether there are any differences that might suggest co- having ‘hypertension’ using conventional existing disease or anatomical variation. The ions of two or more lifestyle modifications blood pressure readings should then be repeated could achieve even better results. However, have ‘white coat hypertension’ and may not with the patient in the standing position to check in practice it still seems that many patients find the theory easier to get to grips withthan the application of it, and this is one systolic or diastolic differences described, blood pressure reading should be used for in the sitting position, at the initial visit is the most effective method of determining standing position. This is so that any degree result of ‘white coat hypertension’ or of postural drop can be assessed and taken into consideration in the drug managementof the patients.
  At the initial visit where should his blood What additional lifestyle measures should above: This patient is overweight, does little
  to consider lifestyle factors, such as his diet, drinking habits and exercise, might therefore, lifestyle advice.4 The guidelines point out make a significant impact on his blood pressure. NOVEMBER/DECEMBER 2007 PHARMACY IN PRACTICE 4_Learning points.qxp 29/11/2007 14:33 Page 267 Learning points
  In relation to current guidelines how well ideations and should not be used unless the microalbuminuria is ramipril.1 Unfortunat- with ramipril if appropriate. However, he is agent (Irbesartan) — and is taking this second line drug at the maximum evidence- based dose for this group of patients.
  recent large clinical outcome trials hadprovided new information.8 A major change is that of beta-blockers being no longer a is taking atenolol, which is an appropriate preferred initial treatment for hypertension.
  second line drug. The dose is 25mg daily, However, unless there are good reasons for and so it may be possible to increase this already stabilised, it is not recommended precludes the use of bendroflumethiazide.5 He is not taking a calcium channel blocker, above: Weighing patients regularly may help them
  1. National Institute for Health and Clinical Excellence. Clinical Guideline H. Management of type 2 diabetes. Management of added at 5mg daily for four weeks and then blood pressure and blood lipids. National Institute for Healthand Clinical Excellence, London, 2002. Available at: http:// increased to the maximum of 10 mg daily.
  2. Joint Specialty Committee on Renal Medicine of the Royal College of Physicians of London and the Renal Association.