Archive for category Blood Pressure
NICE Guidelines: Hypertension management
Posted by admin in Blood Pressure, Hypertension, ICONS - Stethescope and apple on August 24th, 2011
Hypertension or high blood pressure is common particularly as an individual gets older. It can eventually lead to strokes, heart attacks, heart failure, a type of dementia and kidney disease. It is a cause both of long term chronic disease and premature death. Unless the blood pressure is exceptionally high, most people are unaware there is any problem. The only way to diagnose hypertension is to measure the blood pressure.
And that is where there can be a problem.
Generations of medical students have been made aware of “The White Coat Syndrome.” i.e some individuals have a labile blood pressure that goes up when it is formally measured in a health care setting or even in their own home. The technique of inflating a cuff around the upper arm until it tightens is not a pleasant feeling and this sensation alone can even put the blood pressure up even when an individual is measuring their own blood pressure and there is not a white coat is site! The secret then is to take several readings until you get used to the cuff tightening and record the lowest of these. But the same phenomenon may recur next time you measure. You might call it “Blood Pressure Cuff Tightening Syndrome” but I don’t ever remember hearing that term being used.
Guidelines were issued in England and Wales yesterday by NICE regarding the diagnosis and management of hypertension. They have become aware that hypertension may be over-diagnosed and therefore over-treated because of this problem and the new guidelines make recommendations for home monitoring of BP if it is found to be high in the health care setting.
HYPERTENSION : CLINICAL MANAGEMENT OF PRIMARY HYPERTENSION IN ADULTS -UPDATE
COUNTRY: ENGLAND AND WALES
KEY PRIORITIES FOR IMPLEMENTATION
The following recommendations have been identified as priorities for implementation.
Diagnosing hypertension
If the clinic blood pressure is 140/90 mmHg or higher, offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension. [new 2011] When using ABPM to confirm a diagnosis of hypertension, ensure that at least two measurements per hour are taken during the person’s usual waking hours (for example, between 08:00 and 22:00).
Use the average value of at least 14 measurements taken during the person’s usual waking hours to confirm a diagnosis of hypertension. [new 2011] When using home blood pressure monitoring (HBPM) to confirm a diagnosis of hypertension, ensure that:
for each blood pressure recording, two consecutive measurements are taken, at least 1 minute apart and with the person seated and blood pressure is recorded twice daily, ideally in the morning and evening and
blood pressure recording continues for at least 4 days, ideally for 7 days. Discard the measurements taken on the first day and use the average value of all the remaining measurements to confirm a diagnosis of hypertension. [new 2011]
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Measuring blood pressure at home
Posted by admin in Blood Pressure, Hypertension, ICONS - Breaking news on August 24th, 2011
At last, at last, at last…….
The bells are beginning to ring in the committee rooms where doctors, scientists, economists and others talk.
Learned individuals are coming to the conclusion that maybe, what we, since the beginning of time have always called “The White Coat Syndrome” does really exist and needs to be addressed because it is leading to patients who don’t require it being put on medication for high blood pressure.
Furthermore, and this is the sceptic in me, there is a real sense of urgency now driving these committee decisions, because needless therapy to lower blood pressure is costing the NHS an awful lot of money!
The fact is that many people are nervous about visiting their doctor or a hospital clinic. Why wouldn’t they be? Doctors after all may be the bearers of bad news. In addition, we are all nowadays bombarded with information on how to stay healthy, and we watch documentaries and dramas night after night on TV about the terrible illness that “strike people down” or are our own fault because we don’t eat well enough, exercise well enough, or abstain well enough!
Most doctors I know have been suspicious that too many people with hypertension are being treated unnecessary, but there is nowadays a problem with the “Guidelines” that are continually presented to us. But this enters the political arena and is for another post in the future.
In the meantime this is what the BBC are saying about this news which originates from NICE. More on the original NICE documentation later.
BLOOD PRESSURE GUIDELINES REVISED IN ENGLAND AND WALES
COUNTRY : ENGLAND AND WALES
Patients thought to have high blood pressure should have the diagnosis confirmed at home, according to new guidelines.
Patients in England and Wales will be offered extra checks using a mobile device that records blood pressure over 24 hours, says the watchdog NICE.
A quarter of patients may find visiting a GP stressful, leading to misdiagnosis and being given drugs they do not need.
The move could save the NHS £10.5m a year, predictions suggest.
High blood pressure (blood pressure of 140/90mmHg or more) affects about a quarter of all adults in the UK. It is a leading risk factor for heart disease or stroke and costs the NHS about £1bn a year in drugs alone.
Currently, most patients found to have high blood pressure for the first time are given a formal diagnosis if their blood pressure is raised at two subsequent visits to the doctor.
They may then be prescribed medication to lower their blood pressure.
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Using DASH to lower blood pressure
Posted by admin in Blood Pressure, DIETS, Hypertension, ICONS - Golden apple on November 28th, 2009
COUNTRY : USA
The U.S. Department of Health and Human Services has published an eating plan to lower blood pressure or to prevent high blood pressure (hypertension) developing. The abbreviation DASH stands for Dietary Approaches to Stop Hypertension. The booklet was initially published in 1998 and revised in 2006.
BRIEF EDITION – YOUR GUIDE TO LOWERING YOUR BLOOD PRESSURE WITH DASH
FULL EDITION – YOUR GUIDE TO LOWERING YOUR BLOOD PRESSURE WITH DASH
What you choose to eat affects your chances of developing high blood pressure, or hypertension (the medical term). Recent studies show that blood pressure can be lowered by following the Dietary Approaches to Stop Hypertension (DASH) eating plan—and by eating less salt, also called sodium.
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While each step alone lowers blood pressure, the combination of the eating plan and a reduced sodium intake gives the biggest benefit and may help prevent the development of high blood pressure.
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This booklet, based on the DASH research findings, tells how to follow the DASH eating plan and reduce the amount of sodium you consume. It offers tips on how to start and stay on the eating plan, as well as a week of menus and some recipes. The menus and recipes are given for two levels of daily sodium consumption— 2,300 and 1,500 milligrams per day. Twenty-three hundred milligrams is the highest level considered acceptable by the National High Blood Pressure Education Program. It is also the highest amount recommended for healthy Americans by the 2005 “U.S. Dietary Guidelines for Americans.” The 1,500 milligram level can lower blood pressure further and more recently is the amount recommended by the Institute of Medicine as an adequate intake level and one that most people should try to achieve………….
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