In this section : Cardiac
Deactivation of Implantable Cardioverter Defibrillator
Extravasation of IV Amiodarone
Anticoagulation for AF, DVT and PE
Patients Returning from Interventional Cardiac Procedure
Cardiology Referrals
STEMI Thrombolysis Protocol
STEMI
Hypertensive Emergencies
Rate Control in AF
Heart Failure
Aortic Dissection
Non ST Elevation MI (NSTEMI)
Suspected Acute Coronary Syndrome
Pericardiocentesis
Pacemakers
Indications for Echocardiography
Bradycardia
Narrow Complex Tachycardia
Anti-Platelet Therapy in Coronary Heart Disease
Management of Acute AF
Rhythm Control in AF
Atrial Fibrillation
Hypertension
Ventricular Tachycardia
Cardiogenic Shock Complicating Acute Coronary Syndrome
Telemetry
Hypertension
Last updated 21st March 2024
Last updated on 31st July 2013 by Calum Murray
Causes
- 95% cases are primary/idiopathic, previously known as ‘essential’.
- The remainder are due to drugs, renal, endocrine causes or to coarctation of aorta
- Drugs include NSAIDs, Prednisolone, Cyclosporin, Liquorice, Oestrogen containing oral contraceptives
- Renal causes are renal parenchymal eg GN or renovascular
- Endocrine causes are Conn’s, Cushing’s or Phaeo
Diagnosis & Treatment
Choice of Antihypertensive Drugs and Treatment Targets
Resistant Hypertension
- Defined as clinic BP that remains >140/90mmHg with optimal/best tolerated doses of 3 drugs which will usually be ACEI or ARB plus Amlodipine plus Thiazide
- The options are: check compliance, consider underlying causes, re-emphasise importance of non-drug therapy (salt, weight and alcohol), request ABPM, add a fourth drug
- Consider adding Spironolactone 25mg once daily if serum K<=4.5mmol/l
- Other drugs to consider if Spironolactone not indicated or poorly tolerated are addition of an alternative second diuretic, alpha blocker or bete blocker
Links
Diagrams on this article are © NICE2024 Visual Summary of Hypertension in adults: diagnosis and treatment. . Available from www.nice.org.uk/guidance/ng136 All rights reserved. Subject to Notice of rights
NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.’
Content updated by Chris Isles