British Hypertension Society

Williams B, Poulter NR, Brown MJ, Davis M, Mclimes GT, Potter JF et al. British Hypertension Society guidelines for hypertension management 2004 (BHS-IV) summary. BMJ 2004 328(7440) 634-40. 

British Cardiac Society, British Hypertension Society, Diabetes UK, HEART UK, Primary Care Cardiovascular Society and The Stroke Association (2005) JBS 2 Joint British Societies guidelines on prevention of cardiovascular disease in clinical practice. Heart 91 vl-v52. 

As a general rule, the treatment of hypertension in patients with renal impairment follows the British Hypertension Society and NICE guidelines, as detailed below. 

The British Hypertension Society recommendations are shown in Figure A15.1 overleaf. 

Following the guidelines of the British Hypertension Society, Mr WD should be prescribed a thiazide diuretic and a calcium channel blocker, so a good combination might be nifedipine LA 20 mg or 30 mg once daily or amlodipine 5 mg once daily, plus bendroflumethiazide 2.5 mg once daily. However, we know that his renal function is poor, with a calculated GFR of approximately 25 mL/min, so he is borderline for thiazides to be clinically effective. In this instance, it might be prudent to prescribe an ACE inhibitor instead, for example, enalapril 5-fO mg twice daily. 

The British Hypertension Society and NICE recommend that BP should be measured with the patient sitting (the British Hypertension Society recommends for at least 3 minutes) with the arm supported in a horizontal position at the level of the mid-sternum, If the BP is found to be raised, a second measurement should be made after at least 1 minute (preferably at the end of the consultation). If there are symptoms suggestive of postural hypotension, BP should be measured with the patient standing up for at least 1 minute. 

You ll find many brands of blood pressure monitors in the marketplace. Two excellent choices are Omron and LifeSource, both certified accurate by the British Hypertensive Society, internationally recognized for evaluating blood pressure monitoring devices. Omron is more widely distributed and is very respected. LifeSource has some extra features, including an indicator of cardiac arrhythmias, or heartbeat disturbances, on certain models. You can find Omron in pharmacies, discount stores, and online. Check out LifeSource as well at www.lifesourceonline.com. You ll be happy with either product. 

The British Hypertension Society guidelines require that antihypertensive drug therapy be initiated ... 

The British Hypertension Society Guidelines are available in summary form in the BMJ 1999 319 630-635 or online at http / / www.bhsoc.org... 

A simple stepped regimen in keeping with the 1999 British Hypertension Society guidelines is the AB/CD schema illustrated in Figure 23.2 ... 

Wood D et al 1998 Joint British recommendations on prevention of coronary heart disease in clinical practice. Heart 80(Suppl) Sl-29. (British Cardiac Society, British Hyperlipidaemia Association, British Hypertension Society, British Diabetic Association). 

Adapted from Williams, B., Poulter, N.R., Brown, M.J. et al. (2004) The BHS Working Party British Hypertension Society guidelines for hypertension management, 2004-BHS IV summary. 

Hyperiipidaemia is a high risk factor for cardiovascular disease (CVD) and enhances other risk factors such as smoking, excessive alcohol consumption, lack of exercise, diabetes, hypertension, obesity and abdominal distribution of body fat. The risk of CVD over the next 10 years is estimated for an individual using guidelines produced by the British Hypertension Society (or the Joint British Societies Cardiac Risk Assessor ), which include age, gender, smoking history, blood pressure and TC HDL ratios. This estimate is used to determine suitable treatment. 

Notes-. ESH/ESC European Society of Hypertension-European Society of Cardiology guidelines, 2003 and 2007 JNC/7 seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, 2003 BHS report of the fourth working party of the British Hypertension Society, 2004 and update of the NICE Hypertension Guidelines, 2006. 

Williams, B, Poulter, NR, Brown, MJ, Davis, M, Mclnnes, GT, Potter, JF, Sever, PS, McG, TS Guidelines for management of hypertension report of the fourth working party of the British Hypertension Society, 2004-BHS IV. J. Hum. Hypertens. 18 139-185, 2004. 

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