2.5 Hypertension and heart failure

Hypertension

See NICE Hypertension guidance and ESC hypertension guideline 2018.

Choice of hypertensive drug and BP targets are summarised in the NICE 2-page visual summary.

• Local expert clinicians advise that in significantly raised blood pressure initiating 2 antihypertensive agents may be an option. Consider initiating 2 antihypertensive agents in people with stage 2 hypertension (clinic BP systolic >160mmHg or diastolic >100mmHg). Preferred combination is an ACE or ARB with a CCB or diuretic. Exceptions are frail older patients and those at low risk and with stage 1 hypertension (particularly if SBP is <150mmHg)
• Offer antihypertensive drug treatment to women of child-bearing potential in line with the recommendations on management of pregnancy with chronic hypertension and breastfeeding in ‘Hypertension in Pregnancy’ (NICE NG133)

Heart Failure

See NICE NG106 for the management of chronic heart failure in adults.

Pharmacological treatment should be used as per NICE NG106 recommendations. Refer to relevant formulary sections, for example:

• 2.5.5 ACE inhibitors and ARBs
• 2.4 Beta-blockers
• 2.2.3 Mineralocorticoid Receptor Antagonists

Specialist treatments include:

• Ivabradine – refer to section 2.6.3
• Sacubitril/valsartan – refer to section 2.5.5
• Dapagliflozin and empagliflozin – refer to section 6.1.2.5