505:(RACPC) and no patient will wait more than 16 weeks for treatment after they have been seen as an outpatient by a heart specialist who has recommended treatment. Currently, the NHS Scotland lacks systems that capture the total patient journey and have relied on an interim solution, which is to monitor the progress of wait times using component parts of the journey.Additionally, practices are required to complete a CVD risk assessment in people who have been diagnosed with hypertension without confirmed CVD, after April 1, 2009.
337:
designed to improve blood pressure control based on age-related renin levels and appropriate combinations. In June 2006 the
National Institute for Clinical Health and Excellence (NICE) and the BHS jointly released a revised guideline that updated the clinical evidence base to include recent meta-analyses and RCTs and included a cost effectiveness analysis comparing the various blood pressure lowering drug classes.270 The results showed that:
301:(CVD) risk assessment in people who have been diagnosed with hypertension without confirmed CVD, after April 1, 2009. Some NHS Boards have local initiatives that allow for pharmacies to provide blood pressure monitoring services. The action to extend contracts for blood pressure monitoring services in pharmacies is being called into action.
336:
The
British Hypertension Society AB/CD algorithm has been widely adopted for deciding drug therapy for an individual.38 The algorithm was substantially ratified by the ASCOT trial and AB/ CD has now been accepted by JBS2 as the best method of defining combination drug therapy. The AB/CD algorithm was
401:
Patients who fail third-line treatment can further add diuretic therapy, an alpha blocker, or a beta blocker and should consider seeking the advice of a specialist. However, beta blockers are not a preferred initial therapy for hypertension but are an alternative to ACE inhibitors in patients <55
384:
If first-line therapy fails, second-line therapy consists of adding a CCB or a thiazide-type diuretic for patient who initially started an ACE-I or ARB as first-line treatment. For patients who were started on a calcium channel blocker or a thiazide-type diuretic should also be given an ACE-I or and
58:
Current estimates suggest that nearly one-third of the
Scottish population, age 16 years and above, has an elevated blood pressure or a history of high blood pressure. The prevalence of high blood pressure increases sharply with age and more than three-quarters of Scottish age 75 years and above
322:
People with a persistent blood pressure ≥140/90 mm Hg or those with a family history of high blood pressure should be given lifestyle advice that is continued even if drug therapy is started. Individuals with a systolic blood pressures >140 and/or a diastolic blood pressure >90 mm Hg, with
504:
The following current national waiting time standards have been developed for patients who have developed cardiac conditions requiring intervention: no patient will wait more than 16 weeks for cardiac intervention following
General Practice (GP) referral through a rapid access chest pain clinic
351:
The recommendations based on this evidence are summarized below. It incorporates all classes of antihypertensive drugs. Although not specifically validated by a clinical trial, the recommended drug combinations and sequencing are similar to those used in many clinical trials of blood pressure
402:
years in whom ACE inhibitors or ARBs are not tolerated, or contraindicated (includes women of childbearing potential). Black patients are only those of
African or Caribbean descent. In the absence of evidence, all other patients should be treated according to the algorithm as non-black.
288:
The prevalence of high blood pressure of all adults, aged 16 years and above, rose from 32.8% in 2003 to 35.5% in 2010. In 2003, 18.5% of patients were untreated and in 2010, 19.9% of patients were untreated for high blood pressure.
31:
High blood pressure increases the risk of other cardiovascular complications such as coronary heart disease, stroke, heart failure, chronic kidney disease, aortic aneurysm, peripheral vascular disease, and retinal disease. The
393:
When blood pressure goal is not reached after introducing a second-line treatment option, patient should be on three medications: an ACE-I or ARB (not both), a CCB, and a thiazide-type diuretic.
576:
Scottish
Intercollegiate Guidelines Netowrk. Risk estimation and the prevention of cardiovascular disease: A National Clinical Guideline. Edinburgh: SIGN, 2007. (SIGN publication no. 97).
601:
585:
667:- provides prescribers, pharmacists, and other healthcare professionals with sound up-to-date info about the use of medicines (access available to UK residents or
33:
526:
Faculty of Public Health. Easing the
Pressure: Tackling Hypertension. A toolkit for developing a local strategy to tackle high blood pressure (2005).
602:
http://www.isdscotland.org/Health-Topics/Prescribing-and-Medicines/Publications/2012-06-26/2012-06-26-Prescribing-PrescriptionCostAnalysis-Report.pdf
361:
680:
625:
689:- measures achievement against a range of evidence-based indicators, with points and payments awarded according to the level of achievement.
368:(ARB) if the patient is intolerant to the ACE-I. People who are ≥55 years of age or black people of African or Caribbean origin of any age,
365:
344:
calcium channel blockers and thiazide-type diuretics were the most clinically and cost effective choice for the majority of cases
59:
have high blood pressure. The table below depicts the prevalence of high blood pressure in
Scotland by gender from 2003 to 2010:
37:
686:
468:
and high blood pressure, and the 9th most dispensed medication overall, during the fiscal year of 2011/2012 in
Scotland.
542:
658:
613:
652:
435:
410:
The following table depicts the most readily prescribed medications to treat high blood pressure in
Scotland.
369:
36:
has developed guidance, which refers to the British Hypertension Society clinical practice guidelines, for the
626:
http://www.isdscotland.org/Health-Topics/Waiting-Times/Publications/2011-02-22/2011-02-22-WTIPDCOP-Report.pdf
347:
for people under the age of 55, drugs affecting the renin-angiotensin system are likely to be most effective.
674:
373:
298:
341:
beta blockers were the least clinically and cost effective drug at preventing major cardiovascular events
677:- provides information on face-to-face consultations between patients and members of the practice team.
496:
The estimated cost burden of high blood pressure in the U.K. has been estimated to be over £7 billion.
323:
cardiovascular disease, should be considered for a drug therapy that will reduce the blood pressure.
637:
554:
624:
ISD Scotland. Inpatient, Day case and Outpatient stage of treatment waiting times (2011).
527:
584:
The named reference "Tx" was defined multiple times with different content (see the
543:
http://www.scotpho.org.uk/clinical-risk-factors/high-blood-pressure/data/prevalence
614:
http://www.scotpho.org.uk/clinical-risk-factors/high-blood-pressure/introduction
600:
ISD Scotland. Prescribing & Medicines: Prescription Cost Analysis (2012).
461:
430:
541:
Scottish Public Health Observatory. High Blood Pressure: prevalence (2010).
17:
683:- provides information on wait time standards for cardiac interventions.
668:
636:
NHS Scotland. Better Heart Disease and Stroke Care Action Plan, (2009).
553:
NHS Scotland. Better Heart Disease and Stroke Care Action Plan, (2009).
577:
465:
664:
638:
http://www.scotland.gov.uk/Resource/Doc/277650/0083350.pdf
555:
http://www.scotland.gov.uk/Resource/Doc/277650/0083350.pdf
360:
First-line therapy for people <55 years of age is an
528:http://www.fph.org.uk/uploads/hypertension_all.pdf
34:Scottish Intercollegiate Guidelines Network (SIGN)
661:- provides health survey information for Scotland
655:- provides public health information for Scotland
464:was the most dispensed medication used to treat
612:Public Health Information for Scotland (2005).
8:
687:ISD Scotland Quality and Outcomes Framework
310:Ambulatory blood pressure monitoring (ABPM)
412:
61:
519:
362:angiotensin converting enzyme inhibitor
653:The Scottish Public Health Observatory
537:
535:
313:Home blood pressure monitoring (HBPM)
297:Practices are required to complete a
7:
578:http://www.sign.ac.uk/pdf/sign97.pdf
572:
570:
568:
566:
564:
562:
580:
669:HINARI group of developing nations
24:
38:Scottish National Health Service
366:angiotensin II receptor blocker
27:This Article is Only a Mock-up
1:
675:ISD Scotland General Practice
118:All with high blood pressure
376:are the first-line therapy.
704:
681:ISD Scotland Waiting Times
665:British National Formulary
482:Accessibility to treatment
241:Hypertensive uncontrolled
239:
198:
157:
116:
76:
72:
69:
66:
370:calcium channel blockers
200:Hypertensive controlled
406:Most Readily Prescribed
374:thiazide-type diuretics
159:Hypertensive untreated
659:Scottish Health Survey
299:cardiovascular disease
477:Traditional medicines
397:Fourth-line treatment
380:Second-line treatment
492:Socioeconomic impact
389:Third-line treatment
356:First-line treatment
500:Government policies
472:Invasive treatments
487:Treatment programs
459:
458:
281:
280:
695:
640:
634:
628:
622:
616:
610:
604:
598:
592:
591:
590:
589:
574:
557:
551:
545:
539:
530:
524:
509:Challenges ahead
413:
352:lowering drugs.
62:
703:
702:
698:
697:
696:
694:
693:
692:
649:
644:
643:
635:
631:
623:
619:
611:
607:
599:
595:
583:
581:
575:
560:
552:
548:
540:
533:
525:
521:
516:
511:
502:
494:
489:
484:
479:
474:
408:
399:
391:
382:
358:
334:
329:
320:
307:
295:
286:
73:All adults (%)
56:
51:
46:
22:
21:
20:
12:
11:
5:
701:
699:
691:
690:
684:
678:
672:
662:
656:
648:
647:External Links
645:
642:
641:
629:
617:
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558:
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531:
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501:
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470:
457:
456:
454:
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448:
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438:
433:
428:
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423:
420:
417:
407:
404:
398:
395:
390:
387:
381:
378:
364:(ACE-I) or an
357:
354:
349:
348:
345:
342:
333:
330:
328:
325:
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306:
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228:
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219:
216:
213:
210:
207:
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201:
197:
196:
193:
190:
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184:
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178:
175:
172:
169:
166:
163:
160:
156:
155:
152:
149:
146:
143:
140:
137:
134:
131:
128:
125:
122:
119:
115:
114:
111:
108:
105:
102:
99:
96:
93:
90:
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84:
81:
78:
75:
74:
71:
68:
65:
55:
52:
50:
47:
45:
42:
23:
15:
14:
13:
10:
9:
6:
4:
3:
2:
700:
688:
685:
682:
679:
676:
673:
670:
666:
663:
660:
657:
654:
651:
650:
646:
639:
633:
630:
627:
621:
618:
615:
609:
606:
603:
597:
594:
587:
579:
573:
571:
569:
567:
565:
563:
559:
556:
550:
547:
544:
538:
536:
532:
529:
523:
520:
513:
508:
506:
499:
497:
491:
486:
481:
476:
471:
469:
467:
463:
455:
453:
450:
449:
446:
444:
441:
440:
437:
434:
432:
429:
426:
425:
421:
418:
415:
414:
411:
405:
403:
396:
394:
388:
386:
379:
377:
375:
371:
367:
363:
355:
353:
346:
343:
340:
339:
338:
331:
326:
324:
317:
312:
309:
308:
304:
302:
300:
292:
290:
283:
276:
273:
270:
267:
264:
261:
258:
255:
252:
249:
246:
243:
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232:
229:
226:
223:
220:
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214:
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208:
205:
202:
199:
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188:
185:
182:
179:
176:
173:
170:
167:
164:
161:
158:
153:
150:
147:
144:
141:
138:
135:
132:
129:
126:
123:
120:
117:
112:
109:
106:
103:
100:
97:
94:
91:
88:
85:
82:
79:
77:
64:
63:
60:
53:
48:
43:
41:
39:
35:
29:
28:
19:
632:
620:
608:
596:
582:Cite error:
549:
522:
503:
495:
460:
409:
400:
392:
383:
359:
350:
335:
321:
296:
287:
57:
49:Epidemiology
30:
26:
25:
332:Medications
284:Growth rate
514:References
462:Amlodipine
431:amlodipine
419:Medication
327:Management
318:Thresholds
305:Techniques
70:Women (%)
54:Prevalence
586:help page
293:Diagnosis
18:User:GT67
67:Men (%)
44:History
466:angina
422:Class
385:ARB.
195:19.9
192:17.0
189:17.2
186:18.5
183:17.4
180:14.9
177:14.6
174:16.6
171:22.6
168:19.3
165:20.1
162:20.7
154:35.5
151:33.0
148:32.6
145:32.8
142:33.3
139:30.9
136:31.4
133:32.7
130:37.9
127:35.4
124:33.9
121:33.0
113:2010
110:2009
107:2008
104:2003
101:2010
98:2009
95:2008
92:2003
89:2010
86:2009
83:2008
80:2003
16:<
416:Rank
277:8.0
274:8.0
271:6.6
268:7.8
265:9.2
262:8.0
259:7.7
256:9.0
253:6.7
250:7.9
247:5.3
244:6.3
236:7.6
233:8.0
230:8.8
227:6.6
224:6.6
221:7.9
218:9.0
215:7.2
212:8.7
209:8.1
206:8.6
203:5.9
436:CCB
372:or
671:).
588:).
561:^
534:^
40:.
451:3
442:2
427:1
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