2022 Hypertension Update- NICE Guidance
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- เผยแพร่เมื่อ 21 ส.ค. 2022
- This video makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE.
My name is Fernando Florido and I am a GP in the United Kingdom. In this episode I go through the NICE Guideline: Hypertension in adults: diagnosis and management (NG136 guideline), updated on 18th March 2022.
There is a podcast version of the video that you can access here:
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NICE Guideline NG136 can be found here:
www.nice.org.uk/guidance/NG136
Other links referred to in this episode:
• guideline on hypertension in pregnancy
• NICE's guideline on cardiovascular disease
• patient decision aid on treatment options for hypertension
• NICE's guideline on multimorbidity
• NICE guidelines on chronic kidney disease
• type 1 diabetes
• MHRA safety advice on ACE inhibitors and angiotensin II receptor antagonists: not for use in pregnancy, recommendations on how to use for breastfeeding and the related clarification on breastfeeding
• drug therapy for secondary prevention in the NICE guideline on acute coronary syndromes
• treatment after stabilisation in the NICE guideline on acute heart failure
• treating heart failure with reduced ejection fraction in the NICE guideline on chronic heart failure
• drugs for secondary prevention of cardiovascular disease in the NICE guideline on stable angina
• blood pressure management in the NICE guideline on type 1 diabetes in adults.
• NICE's guideline on chronic heart failure
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Hi Dr Fernando, great video. Thanks very much! Would it be possible to cover a few other major chronic conditions please? CKD, asthma etc? Thanks again!
Thank you for your feedback. Precisely Asthma was going to be my next major topic so stay tuned! 👍Hopefully it will not take too long
200 - plus !! This puts my GPs' overdiagnosing in perspective - trying to call a handful of whitecoat readings "hypertension" ... the QRISk calculator will doubtless get me soon even with perfect lipids and BMI - AGE is the one variable I can't change... I already lie about my postcode.
If the doctor who diagnosed me on the phone actually knew me in real life they would stop wasting resources...
Thank you for your comment. You’re right, QRISK is unforgiving and all men above a certain age will be high risk no matter what. But it’s for each person to decide if they want a medical intervention or not 👍
Hello Dr Fernando, this is a great video with lot of information. I am curious about why magnesium /potassium supplement is not advised when there is evidence that these minerals do help in reduction of hypertension. Magnesium deficiency is known to improve diabetes as well.
Hi Arun. Thanks for the comment. I suspect that the answer lies in the way that NICE assesses the evidence. If you look at their “rationale for recommendations” they often say things like “the committee agreed that the study was not adequate to assess the effectiveness of these therapies or to make a recommendation”. So, even if there is evidence, if it’s not strong enough or, even if it’s strong, if it is not cost-effective, they will not recommend it.
The only role of potassium is as potassium chloride to reduce salt / sodium chloride consumption. But not advisable for “older people, people with diabetes, pregnant women, people with kidney disease and people taking some antihypertensive drugs, such as ACE inhibitors and angiotensin II receptor blockers” because of the risk of hyperkalaemia.
@@practicalgp Thank you! Seems very plausible that this is indeed the reason although one wishes they spell out the whys along with the whats. There are always patients able & willing to spend more on a supplement than a medicine simply to minimize side effects. That choice could be left on individuals. Anyhow if there is any channel that NICE has to take feedback, maybe someone like you could provide such feedback in the hope that future recommendations are more insightful & not merely prescriptive.
@@practicalgp Well yes, but then it also needs a dietary recommendation on whether or not foods like potatoes, bananas, spinach etc rich in Potassium may be restricted or not. Of course with periodic blood tests, these mineral imbalances should be caught and corrected.
@@aruns.g.2799 Very true. But NICE do not get involved with every aspect of clinical care. Although they give additional guidance, they tend to focus more on technology appraisal.
Grear video, for Afrocarribean first line is calcium channel blocker except if they are diabetic, then ARB/ACEI becomes the first line. For Caucasians less than age 55, ACEI/ARB is first line and age 55 or above Calcium channel blocker. Any dibstic hypertensive ACEI/ARB becomes first option. I am not sure if you mentioned ACEI /ARB as first line for Afrocarribean. Please clarify thanks
Thank you for your comment. I think that your summary is correct although I am not sure what exactly is your query.
Diabetes of any ethnicity and any age is ACEI/ARB first, then CCB. The only difference with Affro-Caribbeans is that you’d go in preference for ARB instead of ACEI. But you’ll do that in every occasion, even if you use them after a CCB because ARBs are more effective than ACEIs in Affro-Caribbeans (as a result of their low renin status).
This short video may also help, although it’s a very compressed version and 1 minute is not enough time for nuances th-cam.com/users/shortsBnbcUPriJ9g?si=7xUQZe_wflvT3c6h
@@practicalgp I think from the video you said first line for Afrocarribean is ACEI/ARB, though you later read the guidance and corrected it. You can listen to the video again so you can edit it if possible. I am sure it's likely a mistake.
@@ajayiabiodun1456 Could you please tell me where in the video the error is? Are you referring to the slide on minute 19:04? I am sorry if the explanation was not clear there. When I say that you should choose an ARB in preference to an ACEI for Afro-Caribbean patients, I did not mean that it is the step 1 drug of choice, only that, when you face the option between those two, ARBs are more effective for them than ACEIs. The following slide on minute 20:13 talks about the step 1 drugs and it is correct. I am sorry for the confusion
@@practicalgpok I think that's clear now. Thanks
@@ajayiabiodun1456 I am pleased. Thank you for letting me know. Perhaps my choice of words on that slide was not the best. That video is over a year old and I think I should do an updated one on the subject, perhaps a little more concise and to the point. Thank you for your feedback! 👍
Is it now 180/120 - this is opposed to 180/100 in the old guidelines ?
Not sure which section you are referring to but the summary seems to be this:
-If blood pressure measured in the clinic is 180/120 mmHg or higher, we will identify who and how to refer for further investigation and management .
-If clinic blood pressure is between 140/90 mmHg and 180/120 mmHg, we will offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension.
-We will offer antihypertensive drug treatment in addition to lifestyle advice to adults of any age with persistent stage 2 hypertension (which is a clinic blood pressure of 160/100 mmHg or higher.
Is that any clearer?
In practice, we will investigate and treat someone with a BP of 180/120 more or less straightaway whereas for someone with a BP of, say, 179/119, we will refer for ABPM first.
I imagine that the threshold may have been increased thanks to the greater availability of ABPM nowadays.
Thank you
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Thank you for your support. I really appreciate it 🙏👏
I'm 43 years old I have hf with recovered ef from15% to 69% and I've been in hypertensive crisis since 4/22 my doctors have no care plan for me and I'm afraid I can't live very much longer in this condition my current BP is 207/122 85bpm
I think that you should seek urgent medical advice. It sounds like you’ve tried doctors before without success but you mustn’t give up trying until you find a solution