Tag Archives: hypertension

Introduction Hypertension is a highly prevalent condition affecting nearly a third of UK adults.1 It is estimated that 12.8% of worldwide mortality is caused by hypertension.2 The disease affects all ages, all genders and does not differentiate for deprivation, with incidence grossly unchanged in 20 years and numbers of people potentially undiagnosed ever rising.3 Treating blood pressure costs an estimated £2.1 billion to the National Health Service (NHS) every year.4 Blood pressure control is not optimised in around three million people, putting them at an even greater risk.5 In the UK, >90% of hypertension is managed in primary care. Ye

Methodology The priority‑setting project employed a modified Delphi approach grounded in James Lind Alliance principles, combining methodological rigour with inclusive stakeholder engagement. Beginning with a long list of 66 adult and 18 children and young people (CYP) research questions derived from national and international guidelines, as well as expert discussion, the steering group systematically refined and consolidated these into a shortlist of 38 adult and 18 CYP questions. Two rounds of surveys then captured perspectives of clinicians and individuals with lived experience of hypertension, generating a reduced set of 19 questions (

Dr Philip S Lewis Approximately 5% of hypertensives may have a potentially remediable underlying cause, and up to 10% have hypertension resistant to usual therapies.3 The National Institute for Health and Care Excellence (NICE) recommends that these groups, as well as hypertensives under the age of 40 years, are referred to a specialist.4 This number will increase with the realisation that women who develop hypertension in pregnancy are at later significant increased risk of coronary heart disease, stroke and vascular dementia and need specialist follow-up and care.5 A British and Irish Hypertension Society (BIHS) survey estimated that each c

Out of 39 general practices, 20 participated (51%). Concern about increased workload was common, but most were ultimately satisfied, largely because GPs were only involved in managing abnormal results. Using National Institute for Health and Care Excellence (NICE) guidance, patients were selected using blood pressure (BP) readings routinely recorded in electronic health records.3 Eligible patients had no prior diagnosis of hypertension, were not pregnant or nearing the end of life, and had a most recent clinic BP ≥160/100 mmHg or an average home BP ≥155/95 mmHg (stage 2 hypertension). The eligibility thresholds were lowered to 140/90 and

Introduction Hypertension affects ~1 billion people worldwide and is highly prevalent in adults with atrial fibrillation (AF), especially those >60 years old.1 The combination of AF and hypertension has a 1.8–2-fold increased stroke risk compared with those without hypertension.2 Stroke prevention is a key goal in AF and stroke management, and early AF detection and good blood pressure (BP) control are vital care components.3–4 Figure 1. An image illustrating the use of this device in measuring the blood pressure and recording an electrocardiogram (ECG) Image source: OMRON website Devices recording home BP are commonplace, but

SPRINT, ESPRIT and BPROAD were three large RCTs with 9,361, 11,255 and 12,821 participants, respectively, that support a more intensive SBP target closer to 120 mmHg.5–7 These trials recruited patients ≥50 years old at high cardiovascular risk with SBP 130–180 mmHg.5–7 The primary composite outcome in all three trials focused on similar major cardiovascular outcomes: myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, coronary or non-coronary revascularisation, stroke, decompensated heart failure or death from cardiovascular causes. The mean SBP achieved in SPRINT, ESPRIT and BPROAD trials (intensive

In the midst of the first wave of the COVID-19 pandemic in the United Kingdom, we observed new-onset systolic hypertension associated with hypernatraemia and hypokalaemia with normal serum urea among hospitalised patients. We investigated two patients and found elevated urinary potassium (without causal drugs) and hyporeninaemic hypoaldosteronism (plasma renin <0.2 nmol/L/hr [reference range: 0.5–3.5 nmol/L/hr] and aldosterone <60 pmol/L [reference range: 60–250 pmol/L]) in both. Congenital and secondary endocrine causes of hypertension were excluded. We treated one of the patients with amiloride, which resulted in normalisation of

Introduction In late 2019, the first case of a patient with pneumonia of unknown cause was reported in Wuhan, China. The disease, called coronavirus disease 2019 (COVID-19), spread rapidly and caused a pandemic. The virus that causes this infection is called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1 Besides respiratory tract disease, which is considered the main and most common clinical manifestation of COVID-19, other systems, including the cardiovascular system, could also be affected. Factors, such as tissue hypoxia, which results as the pneumonia progresses, and inflammation of the vessel walls, have been suggested a

Introduction Stroke is defined as an acute neurological deficit of cerebrovascular origin lasting longer than 24 hours. In the UK each year, stroke affects approximately 100,000 people, is a leading cause of mortality, causing over 30,000 deaths in 2020, and is a significant contributor to severe disability.1 Caring for patients with stroke in the UK costs approximately £2.5 million each year and leads to significant production losses. Clearly, preventing stroke has many benefits. Strokes can be ischaemic (85%), where tissue damage is due to occlusion of blood supply, or haemorrhagic (15%), due to a ruptured vessel.2 Ischaemic stroke can be

Introduction High blood pressure (BP) is a major risk factor for reduced healthy life-expectancy and unhealthy ageing. While it is fundamentally treatable, it is currently not optimally managed. To meet national public health targets, patients must play an active role in their decisions about how best to manage their own BP through lifestyle change and drug treatment.1,2 This paper summarises ‘Share The Pressure’ (STP), a project that developed and piloted a scalable model for engaging patients on the benefits of risk factor control for healthy ageing; training healthcare professionals (HCPs) in cardiovascular disease (CVD) risk communica