Professor James Rudd discusses the latest NICE guidelines for hypertension and compares them to the American and European guidelines. They explore lifestyle modifications for lowering blood pressure, drug therapy recommendations, and considerations for hypertension treatment in older patients.
The NICE guidelines for hypertension recommend a blood pressure level of less than 140/90, while the AHA targets less than 130/80, reflecting the different approaches to blood pressure control.
Lifestyle modifications including weight loss, moderation of salt intake, and alcohol consumption play a crucial role in managing high blood pressure.
Deep dives
Overview of Hypertension Guidelines
This podcast episode discusses the various guidelines on hypertension, specifically focusing on the new NICE guidelines and comparing them to the European and American guidelines. The episode highlights the importance of guidelines in providing evidence-based recommendations for the treatment of high blood pressure. It emphasizes that while guidelines may have similarities due to the availability of the same data, there are also important differences in how guidelines are written. These differences can arise when there is a lack of data in certain areas, leading to varying approaches in offering guidance. The podcast also mentions the influence of the SPRINT trial, which showed the benefits of tighter blood pressure control in reducing mortality, cardiovascular events, stroke, and possibly the onset of dementia. The guidelines differ in their target blood pressure levels, with NICE aiming for a blood pressure level of less than 140/90 and the AHA targeting less than 130/80. The episode also touches on the use of ambulatory blood pressure monitoring and home blood pressure monitoring as diagnostic tools.
Lifestyle Modifications for Hypertension
Another key point discussed in the podcast is the importance of lifestyle modifications in managing high blood pressure. The episode highlights the impact of weight loss on blood pressure reduction, with every kilogram of weight loss resulting in about a 1.5 mmHg reduction in blood pressure. The role of salt intake and alcohol consumption in driving blood pressure is also emphasized. The episode mentions that the recommended salt intake is approximately 3 to 5 grams per day, which includes salt already present in food. It stresses the importance of moderation rather than complete elimination of salt and alcohol. Additionally, the podcast touches on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and their impact on blood pressure, as well as the potential benefits of reducing sodium intake and alcohol consumption in blood pressure management.
Treatment Recommendations and Drug Therapy
The episode delves into the recommendations for drug therapy in hypertension based on factors such as age, renal hypertension, and ethnicity. It mentions that younger individuals with high renal hypertension are often prescribed drugs that affect the renal angiotensin system, such as ACE inhibitors or ARBs. Older individuals with low renal hypertension may start with calcium channel blockers or thiazide-like diuretics. The episode highlights that most individuals with hypertension require more than one drug for blood pressure control, and the combination of different drugs is often effective. It particularly emphasizes the strength of the NICE guidelines in simplifying blood pressure management and using multiple drugs to achieve target blood pressure levels.
Gaps in Knowledge and Ongoing Research
The podcast discusses the absence of data and guidelines regarding hypertension management in individuals older than age 87. It mentions the need for further research in this area and the challenges of deciding on treatment approaches for this age group. The episode also touches on ongoing trials and potential future interventions such as renal denervation, which is being explored as a treatment option for hypertension. While the long-term benefits of renal denervation are still being determined, it is seen by some patients as an alternative to medication. The importance of continuous research, data collection, and guideline writing is emphasized, with the podcast encouraging healthcare professionals to get involved in guideline development and contribute to shaping treatment practices.
In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by Professor Adrian Brady from Glasgow. They discuss the latest NICE guidelines for hypertension, and how they compare to the American and European guidelines. If you enjoy the show, please leave us a podcast review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2 or wherever you get your podcasts - it's really helpful.
