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1、<p><p>&lt;p&gt;&amp;lt;p&amp;gt;&amp;amp;lt;p&amp;amp;gt;Pete and Mihir ?Why theyre important ?Which risk factors? ?Risk assessment ?Curriculum statements ? 5 Healthy people, promoting health and preventing disease ? 15.1 Cardiovasc
2、ular problems ?QOF - In those patients with a new diagnosis of hypertension (excluding those with pre- existing CHD, diabetes, stroke and/or TIA) recorded between the preceding 1 April to 31 March: the percentage of patients aged 30 to 74 years who have had a face-to-face cardiovascular risk assessm
3、ent at the outset of diagnosis (within 3 months of the initial diagnosis) using an agreed risk assessment tool ?8 Points ?Disease Prevalence ?That warm fuzzy feeling that comes in the knowledge you are saving peoples lives (by reducing 10 year cardiovascular end point incidence) ?45,000 ?Lifestyle f
4、actors you can change ?Factors you cant change ?Factors that can be treated ?Family History ?Male ?Age ?Extreme baldness ?Early menopause ?Age ?Ethnic group ?Smoking ?Sedentary lifestyle ?Obesity ?Salt/diet ?Alcohol ?Hypertension ?Cholesterol ?triglycerides ?diabetes ?Chronic kidney disease ?Anyone
5、age 40-74 who is likely to be at high risk calculate risk with data already available (NICE) ?Anyone over 40 (JBS2) ?The following patients should not have their risk calculated, as they are considered already to be at high enough risk to justify lifestyle and other interventions ? Patients with ath
6、erosclerotic CVD. ? Hypertension (160/100 mm Hg) with target organ damage. ? Patients with type 1 or type 2 diabetes mellitus. ? Renal dysfunction (including diabetic nephropathy). ? Familial hypercholesterolaemia, familial combined hyperlipidaemia ? People aged 75 or older should also be considered
7、 at increased risk of CVD, particularly if hypertensive or smokers. ?Use a validated tool to calculate estimated 10 year risk. ?Discuss lifestyle modification ?Start/change treatment ?Framingham with JBS2 adjustments ?QRisk2 ?Type 2 diabetes (early on) ? UKPDS ?Tends to overestimate UK population ri
8、sk ?Underestimates risk of socially deprived/south asian/female populations ?Age (30-74) ?Smoking Status ?Sex ?Glucose ?LVH ?BP ?Central Obesity ?Total Cholesterol ?South Asian Origin ?HDL Cholesterol ?Family History of CVD (Men 55 and women 65 years) ?Total /HDL Ratio ?Serum TG mmol/L ?Patient age
9、(30-84). ?Patient gender. ?Current smoker (yes/no). ?Diabetic. ?Family history of heart disease aged 60 (yes/no). ?Treatment with blood pressure agent . ?Postcode (Townsend score) ?Body mass index (height and weight). ?Systolic blood pressure (use current not pre-treatment value). ?Total and HDL cho
10、lesterol. ?Ethnicity. ?Rheumatoid arthritis. ?Chronic kidney disease. ?Atrial fibrillation. ?http:/www.patient.co.uk/doctor/Primary- Cardiovascular-Risk-Calculator.htm ?www.qrisk.org ?www.dtu.ox.ac.uk Is it a disease? Is it an illness? Is it a condition? Is it a syndrome? What is it? Hypertension is
11、 the one of the most important preventable causes of morbidity and mortality in the UK It is a major risk factor for cardiovascular disease At least one quarter of adults (and more than half of those are above 60) in the UK have high blood pressure 2mmHg rise in systolic BP causes 7% increased risk
12、of mortality in IHD and 10% increased risk of mortality from stroke The NHS spent &amp;amp;amp;#163;1 billion on drug costs alone on blood pressure management in 2006 140/90? 135/85? 160/100? 180/110? Stage 1 Hypertension: Clinic blood pressure is 140/90mmHg or higher and subsequent ABPM day
13、time average or HBPM average blood pressure of135/85mmHg or higher Stage 2 Hypertension: Clinic blood pressure is 160/100mmHg or higher and subsequent ABPM daytime average or HBPM average blood pressure of 150/95mmHg or higher Severe Hypertension: Clinic systolic BP is 180mmHg or higher, or clinic d
14、iastolic BP is 110mmHg or higher Adequate initial training and periodic review Automated devices regularly recalibrated. Do not use automated devices if there is pulse irregularity Standardize environment. Patient should be quiet and seated, with an outstretched and supported arm For postural hypote
15、nsion patient should be stood for at least 1 minute before BP measurement (If SBP falls by 20mmHg Review medication/Specialist referral) If clinic BP is 140/90, offer ABPM to confirm diagnosis of HTN Clinic BP Measure BP in both arms (Use arm with higher reading), if BP 140/90mmHg repeat BP. If subs
16、tantially different repeat a third time. Record the lower of the last 2 measurements as clinic BP ABPM At least 2 measurements per hour during waking hours Use the average value of at least 14 measurements taken during usual waking hours HBPM For each BP reading, two consecutive measurements are tak
17、en, at least 1 minute apart and with the person seated Record twice daily, ideally morning and evening Record for at least 4 days, ideally 7 days (Discard first days readings) Use formal calculator Test for proteinuria and haematuria Estimation of the albumin:creatinine ratio Bloods for plasma glucose, U 7, 14, 21 mg/24 hr (NiQuitin&amp;amp;lt;/p&amp;amp;gt;&amp;lt;/p&amp;gt;&lt;/p&gt;</p></p>
