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British Cardiac Patients Association

The American College of Cardiology conference on 17-20 March 2002, will offer a sneak preview of the latest research in cardiovascular medicine and an in-depth update on sub-specialities which effects up to 10 million people in the UK.

What are the problems associated with treating hypertension?
· Consistent treatment i.e. patients staying on therapy, decreases both mortality and morbidity associated with hypertension1
· 40-50% of patients on beta-blockers, calcium channel blockers and ACE inhibitors discontinue their medication after six months due to problems with side effects2
· Patients failing to stay on therapy due to side effect problems results in suboptimal treatment which in turn is associated with considerably higher rates of readmission to hospital for hypertensive crises3,4
· The cost of stroke to the NHS is estimated to be over £2.3 billion5
· Stroke victims occupy around 20 percent of all acute hospital beds and one-quarter of long-term beds6

There are many treatment options available to hypertensive patients including diuretics, beta blockers, calcium channel blockers, ACE inhibitors and angiotensin II receptor antagonists (AIIAs). However, due to the side effects related to some of these anti-hypertensive drugs, and the fact that people often experience no symptoms of hypertension, compliance is poor i.e. patients will stop taking their medication.

What is the government doing to help people with hypertension?
The government have recognised Coronary Heart Disease (CHD) as one of the biggest killers this country and introduced a range of measures to raise quality and decrease variations in service including National Service Frameworks (NSFs). NSFs do the following:
· set national standards and define service models for a defined service or care group;
· put in place strategies to support implementation; and
· establish performance milestones against which progress within an agreed time-scale will be measured.

The NSF for Coronary Heart Disease7 (http://www.doh.gov.uk/nsf/coronary.htm) states: ‘Heart disease is more common in deprived areas, yet treatment and care is often better in prosperous areas. This “postcode” lottery of care is unacceptable and we are determined to put and end to it.’

As a result of this NSF:
1. NHS will develop policies that reduce the prevalence of coronary risk factors, and reduce inequalities in risks of developing disease i.e. by providing advice on lifestyle changes and advice and treatment to maintain low blood pressure below 140/85 mm Hg
2. General practitioners should identify all people with cardiovascular disease and offer comprehensive advice and appropriate treatment to reduce their risks

In addition, the NSF for Diabetes8 - http://www.doh.gov.uk/nsf/diabetes/ addresses blood pressure management: ‘Diabetes can have a devastating effect on individuals and their families. By improving blood glucose and blood pressure control we could reduce complications of diabetes, reducing the resulting number of heart attacks and strokes, blindness and renal failure perhaps by as much as a third.’

As a result of this NSF:
1. All adults with diabetes will receive high-quality care throughout their lifetime including support to optimise the control of blood glucose, blood pressure and other risk factors for developing complications of diabetes. Up to 70% of adults with Type 2 diabetes have raised blood pressure and more than 70% have raised cholesterol levels. Both increase the risk of developing cardiovascular disease as well as microvascular complications. Tight blood pressure control improves health outcome in people with Type 2 diabetes.

What are healthcare professionals doing to help people with hypertension?
In 1999 the British Hypertension Society (BHS) introduced guidelines for hypertension management8a (http://www.hyp.ac.uk/bhs/managemt.html) following evidence that physicians on the whole adhered to the recommendations provided.9 The 1999 guidelines provide the following advice for treatment:
· All adults should have blood pressure measured routinely at least every 5 years until the age of 808a
· Optimal BP treatment targets are:8a
- systolic BP <140mmHg and diastolic <85mmHg
- Minimum accepted level of control recommended is <150/<90mmHg
· For most a combination of antihypertensive drugs are required to achieve recommended BP targets.

References:
1. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1991; 265: 3222-3264

2. Jones JK, Gorkin L, Lian JF et al. Discontinuation of and changes in treatment after start of new courses of drugs: a study of a United Kingdom population. BMJ 1995; 311: 293-295

3. Maronde RF, Chan LS, Larsen FJ et al. Underutilization of antihypertensive drugs and associated hospitalization. Med Care 1989; 27: 1159-1166

4. Psaty BM, Koepsell TD, Wagner EH et al. The relative risk of incident coronary heart disease associated with recently stopping use of B-blockers. JAMA 1990; 263: 1653-1657

5. Maynard J. Antihypertensive drugs and monitoring. Practice Nursing 2001; 12(9): 369-371

6. The Stroke Association. Stroke – Facts and Figures. Visited on 18 February 2002. Available at: www.stroke.org.uk/noticeboard/facts.htm

7. Department of Health (2000). National Service Framework for Coronary Heart Disease. The Stationary Office, London.

8. Ramsey LE, Williams B, Johnston GD et al. British Hypertension Society: Guidelines for hypertension management report of the British Hypertension Society. J Hum Hyperten. 1999; 13: 569-592

8a. Department of Health (2001). National Service Framework for Diabetes. The Stationary Office, London.

9. Dickerson JEC, Garratt CJ, Brown MJ. Management of hypertension in general practice: agreements with and variations from the British Hypertension Society guidelines. J Hum Hypertens. 1995; 9:835-839

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