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Significant Hypertension

Please click here for a visual summary of the latest NICE guidance, Aug 2019.

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Please note, same day specialist assessment is reserved for those with a BP over (either systolic or diastolic in excess of) 180/120 mmHg AND 

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Malignant hypertension criteria (2)

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retinal haemorrhage or papilloedema (accelerated hypertension) or, often with a severre headache and blood and protein in the urine

life-threatening symptoms such as new onset confusion, chest pain, signs of heart failure, or acute kidney injury or

suspected pheochromocytoma (for example, labile or postural hypotension, headache, palpitations, pallor, abdominal pain or diaphoresis)*

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​Without these indications to admit, the Renal team have developed the following advice:

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(1) Add-on therapy:​

Aim to get a balance between the angiotensin system blockade, beta blockers and vasodilators (they workj in synchrony.

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(2) Malignant hypertension criteria - see top of page

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(3) Increase in therapy:

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(4) Booking ultrasound:

For Virtual Ward referrals oly: Request the ultrasound as "Urgent Outpatient" under Responsible Clinician Dr Mark Battle

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*More on clinical presentation of pheochromocytoma

Symptoms and signs of pheochromocytoma include the following:

  • Headache

  • Sweating

  • Palpitations

  • Tremor

  • Nausea

  • Weakness

  • Pallor

  • Anxiety, sense of doom

  • Epigastric pain

  • Flank pain

  • Constipation

  • Weight loss

The classic history of a patient with a pheochromocytoma includes spells characterized by headaches, palpitations, and diaphoresis in association with severe hypertension. These 4 characteristics together are strongly suggestive of a pheochromocytoma. In the absence of these 3 symptoms and hypertension, the diagnosis may be excluded. (Blake 2020 Medscape.com)

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Camborne-Redruth Hospital

Barncoose Terrace

Cornwall

TR15 3ER

For Life-Threatening Emergencies Call 999

© 2024 by Acute GP Service, CPFT. 

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