British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary

• Published in: BMJ Vol. 328; no. 7440; pp. 634 - 640
• Main Authors: Williams, Bryan, Poulter, Neil R, Brown, Morris J, Davis, Mark, McInnes, Gordon T, Potter, John F, Sever, Peter S, Thom, Simon McG
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 13.03.2004; BMJ Publishing Group; British Medical Association; BMJ Publishing Group LTD; BMJ Publishing Group Ltd
• Edition: International edition
• Subjects: Algorithms; Antihypertensive Agents - therapeutic use; Antihypertensives; Arterial hypertension. Arterial hypotension; Aspirin - therapeutic use; Biological and medical sciences; Blood and lymphatic vessels; Blood pressure; Blood Pressure Determination - methods; Cardiology. Vascular system; Cardiovascular agents; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Diabetes; Diabetic nephropathies; Diastolic blood pressure; Disease prevention; Education and Debate; Guidelines; Heart; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hypertension; Hypertension - prevention & control; Hypertension - therapy; Life Style; Lifestyle; Lifestyles; Medical History Taking - methods; Medical sciences; National service; Physical Examination - methods; Platelet Aggregation Inhibitors - therapeutic use; Primary care; Risk Assessment; Society; Statins; Substance abuse treatment; United Kingdom; Europe; UK; Human; Hypertension; Clinical management; Treatment; 2004; Cardiovascular disease; Evidence-based medicine; Recommendation; Public health
• ISSN: 0959-8138; 0959-8146; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.328.7440.634

To promote the primary prevention of hypertension and cardiovascular disease by changes in the diet and lifestyle of the whole population To increase the detection and treatment of undiagnosed hypertension by routine screening and increase awareness of hypertension among the public To ensure that patients taking antihypertensive drugs are controlled to optimal blood pressure levels To reduce the risk of cardiovascular disease of treated hypertensive patients by non-pharmacological measures, and by appropriate use of statin and aspirin treatment To increase the identification and treatment of patients with mild hypertension who are at high risk of cardiovascular disease-for example, elderly patients, patients with ischaemic heart disease, people with diabetes, people with target organ damage, or people with multiple risk factors To promote continued adherence to drug treatment, by optimising the choice and use of drugs, minimising side effects, and increasing information and choice for patients. Blood pressure measurement by standard mercury sphygmomanometer or semiautomated device Use a properly maintained, calibrated, and validated device Measure sitting blood pressure routinely: standing blood pressure should be recorded at least at the initial estimation in elderly or diabetic patients Remove tight clothing, support arm at heart level, ensure arm relaxed and avoid talking during the measurement procedure Use cuff of appropriate size (see box 3 in the full guidelines, 3 http://www.bhsoc.org/ ) Lower mercury column slowly (2 mm per second) Read blood pressure to the nearest 2 mm Hg Measure diastolic blood pressure as disappearance of sounds (phase V) Take the mean of at least two readings, more recordings are needed if marked differences between initial measurements are found Do not treat on the basis of an isolated reading For full details of methods see http://www.bhsoc.org/ and reference 8 Absolute risk of cardiovascular disease estimation The treatment of hypertension and the primary prevention of cardiovascular disease should be informed by assessment of total risk of cardiovascular disease.\n The minimum acceptable level of control (audit standard) recommended is < 150/ < 90 mm Hg In people with diabetes mellitus, initiate antihypertensive drug treatment if systolic blood pressure is sustained â[per thousand]¥ 140 mm Hg or diastolic blood pressure is sustained â[per thousand]¥ 90 mm Hg In hypertensive people with diabetes, chronic renal disease, or established cardiovascular disease optimal blood pressure goals are systolic blood pressure < 130 mm Hg and diastolic blood pressure < 80 mm Hg.