Person—blood pressure (diastolic) (measured), millimetres of mercury NN[N]

DSS specific information:

In the primary care setting, blood pressure on both arms should be measured at the first visit, particularly if there is evidence of peripheral vascular disease.

Variation of up to 5 mm Hg in blood pressure between arms can be acceptable. In certain conditions (e.g. chronic aortic dissection, subclavian artery stenosis) all blood pressure recordings should be taken from the arm with the highest reading.

Measure sitting and standing blood pressures in elderly and diabetic patients or in other situations in which orthostatic hypotension might be suspected.

Measure and record heart rate and rhythm. Note: Atrial fibrillation in a patient with hypertension indicates increased risk of stroke.

In all patients, consideration should be given to obtaining blood pressure measurements outside the clinic setting either by self-measurement of blood pressure at home or by non-invasive ambulatory blood pressure monitoring.

Target-organ damage and cardiovascular outcome relate more closely to blood pressures measured outside the clinic, particularly with ambulatory monitoring. An accurate, reliable machine and technique are essential if home blood pressure monitoring is to be used. In up to 30% of patients who are hypertensive in the clinic, blood pressure outside the clinic is within acceptable limits ('white coat' hypertension).

High blood pressure is a major risk factor for coronary heart disease, heart failure, stroke, and renal failure with the risk increasing along with the level of blood pressure (Ashwell 1997; DHSH 1994b; Whelton 1994; Kannel 1991). The higher the blood pressure, the higher the risk of both stroke and coronary heart disease. The dividing line between normotension and hypertension is arbitrary.
Both systolic and diastolic blood pressures are predictors of heart, stroke and vascular disease at all ages (Kannel 1991), although diastolic blood pressure is a weaker predictor of death due to coronary heart disease (Neaton & Wentworth 1992).

The risk of disease increases as the level of blood pressure increases. When blood pressure is lowered by 4-6 mm Hg over two to three years, it is estimated that the risk reduces by14 per cent in patients with coronary heart disease and by 42 per cent in stroke patients (Collins et al 1990; Rose 1992.) When high blood pressure is controlled by medication, the risk of cardiovascular disease is reduced, but not to the levels of unaffected people.

In settings such as general practice where the monitoring of a person's health is ongoing and where a measure can change over time, the service contact date should be recorded.

DSS specific information:

In the primary care setting, blood pressure on both arms should be measured at the first visit, particularly if there is evidence of peripheral vascular disease.

Variation of up to 5 mm Hg in blood pressure between arms can be acceptable. In certain conditions (e.g. chronic aortic dissection, subclavian artery stenosis) all blood pressure recordings should be taken from the arm with the highest reading.

Measure sitting and standing blood pressures in elderly and diabetic patients or in other situations in which orthostatic hypotension might be suspected.

Measure and record heart rate and rhythm. Note: Atrial fibrillation in a patient with hypertension indicates increased risk of stroke.

In all patients, consideration should be given to obtaining blood pressure measurements outside the clinic setting either by self-measurement of blood pressure at home or by non-invasive ambulatory blood pressure monitoring.

Target-organ damage and cardiovascular outcome relate more closely to blood pressures measured outside the clinic, particularly with ambulatory monitoring. An accurate, reliable machine and technique are essential if home blood pressure monitoring is to be used. In up to 30% of patients who are hypertensive in the clinic, blood pressure outside the clinic is within acceptable limits ('white coat' hypertension).

High blood pressure is a major risk factor for coronary heart disease, heart failure, stroke, and renal failure with the risk increasing along with the level of blood pressure (Ashwell 1997; DHSH 1994b; Whelton 1994; Kannel 1991). The higher the blood pressure, the higher the risk of both stroke and coronary heart disease. The dividing line between normotension and hypertension is arbitrary.
Both systolic and diastolic blood pressures are predictors of heart, stroke and vascular disease at all ages (Kannel 1991), although diastolic blood pressure is a weaker predictor of death due to coronary heart disease (Neaton & Wentworth 1992).

The risk of disease increases as the level of blood pressure increases. When blood pressure is lowered by 4-6 mm Hg over two to three years, it is estimated that the risk reduces by14 per cent in patients with coronary heart disease and by 42 per cent in stroke patients (Collins et al 1990; Rose 1992.) When high blood pressure is controlled by medication, the risk of cardiovascular disease is reduced, but not to the levels of unaffected people.

In settings such as general practice where the monitoring of a person's health is ongoing and where a measure can change over time, the service contact date should be recorded.

DSS specific information:

In the primary care setting, blood pressure on both arms should be measured at the first visit, particularly if there is evidence of peripheral vascular disease.

Variation of up to 5 mm Hg in blood pressure between arms can be acceptable. In certain conditions (e.g. chronic aortic dissection, subclavian artery stenosis) all blood pressure recordings should be taken from the arm with the highest reading.

Measure sitting and standing blood pressures in elderly and diabetic patients or in other situations in which orthostatic hypotension might be suspected.

Measure and record heart rate and rhythm. Note: Atrial fibrillation in a patient with hypertension indicates increased risk of stroke.

In all patients, consideration should be given to obtaining blood pressure measurements outside the clinic setting either by self-measurement of blood pressure at home or by non-invasive ambulatory blood pressure monitoring.

Target-organ damage and cardiovascular outcome relate more closely to blood pressures measured outside the clinic, particularly with ambulatory monitoring. An accurate, reliable machine and technique are essential if home blood pressure monitoring is to be used. In up to 30% of patients who are hypertensive in the clinic, blood pressure outside the clinic is within acceptable limits ('white coat' hypertension).

High blood pressure is a major risk factor for coronary heart disease, heart failure, stroke, and renal failure with the risk increasing along with the level of blood pressure (Ashwell 1997; DHSH 1994b; Whelton 1994; Kannel 1991). The higher the blood pressure, the higher the risk of both stroke and coronary heart disease. The dividing line between normotension and hypertension is arbitrary.
Both systolic and diastolic blood pressures are predictors of heart, stroke and vascular disease at all ages (Kannel 1991), although diastolic blood pressure is a weaker predictor of death due to coronary heart disease (Neaton & Wentworth 1992).

The risk of disease increases as the level of blood pressure increases. When blood pressure is lowered by 4-6 mm Hg over two to three years, it is estimated that the risk reduces by14 per cent in patients with coronary heart disease and by 42 per cent in stroke patients (Collins et al 1990; Rose 1992.) When high blood pressure is controlled by medication, the risk of cardiovascular disease is reduced, but not to the levels of unaffected people.

In settings such as general practice where the monitoring of a person's health is ongoing and where a measure can change over time, the service contact date should be recorded.

DSS specific information:

In the primary care setting, blood pressure on both arms should be measured at the first visit, particularly if there is evidence of peripheral vascular disease.

Variation of up to 5 mm Hg in blood pressure between arms can be acceptable. In certain conditions (e.g. chronic aortic dissection, subclavian artery stenosis) all blood pressure recordings should be taken from the arm with the highest reading.

Measure sitting and standing blood pressures in elderly and diabetic patients or in other situations in which orthostatic hypotension might be suspected.

Measure and record heart rate and rhythm. Note: Atrial fibrillation in a patient with hypertension indicates increased risk of stroke.

In all patients, consideration should be given to obtaining blood pressure measurements outside the clinic setting either by self-measurement of blood pressure at home or by non-invasive ambulatory blood pressure monitoring.

Target-organ damage and cardiovascular outcome relate more closely to blood pressures measured outside the clinic, particularly with ambulatory monitoring. An accurate, reliable machine and technique are essential if home blood pressure monitoring is to be used. In up to 30% of patients who are hypertensive in the clinic, blood pressure outside the clinic is within acceptable limits ('white coat' hypertension).

High blood pressure is a major risk factor for coronary heart disease, heart failure, stroke, and renal failure with the risk increasing along with the level of blood pressure (Ashwell 1997; DHSH 1994b; Whelton 1994; Kannel 1991). The higher the blood pressure, the higher the risk of both stroke and coronary heart disease. The dividing line between normotension and hypertension is arbitrary.
Both systolic and diastolic blood pressures are predictors of heart, stroke and vascular disease at all ages (Kannel 1991), although diastolic blood pressure is a weaker predictor of death due to coronary heart disease (Neaton & Wentworth 1992).

The risk of disease increases as the level of blood pressure increases. When blood pressure is lowered by 4-6 mm Hg over two to three years, it is estimated that the risk reduces by14 per cent in patients with coronary heart disease and by 42 per cent in stroke patients (Collins et al 1990; Rose 1992.) When high blood pressure is controlled by medication, the risk of cardiovascular disease is reduced, but not to the levels of unaffected people.

In settings such as general practice where the monitoring of a person's health is ongoing and where a measure can change over time, the service contact date should be recorded.

DSS specific information:

In the primary care setting, blood pressure on both arms should be measured at the first visit, particularly if there is evidence of peripheral vascular disease.

Variation of up to 5 mm Hg in blood pressure between arms can be acceptable. In certain conditions (e.g. chronic aortic dissection, subclavian artery stenosis) all blood pressure recordings should be taken from the arm with the highest reading.

Measure sitting and standing blood pressures in elderly and diabetic patients or in other situations in which orthostatic hypotension might be suspected.

Measure and record heart rate and rhythm. Note: Atrial fibrillation in a patient with hypertension indicates increased risk of stroke.

In all patients, consideration should be given to obtaining blood pressure measurements outside the clinic setting either by self-measurement of blood pressure at home or by non-invasive ambulatory blood pressure monitoring.

Target-organ damage and cardiovascular outcome relate more closely to blood pressures measured outside the clinic, particularly with ambulatory monitoring. An accurate, reliable machine and technique are essential if home blood pressure monitoring is to be used. In up to 30% of patients who are hypertensive in the clinic, blood pressure outside the clinic is within acceptable limits ('white coat' hypertension).

High blood pressure is a major risk factor for coronary heart disease, heart failure, stroke, and renal failure with the risk increasing along with the level of blood pressure (Ashwell 1997; DHSH 1994b; Whelton 1994; Kannel 1991). The higher the blood pressure, the higher the risk of both stroke and coronary heart disease. The dividing line between normotension and hypertension is arbitrary.
Both systolic and diastolic blood pressures are predictors of heart, stroke and vascular disease at all ages (Kannel 1991), although diastolic blood pressure is a weaker predictor of death due to coronary heart disease (Neaton & Wentworth 1992).

The risk of disease increases as the level of blood pressure increases. When blood pressure is lowered by 4-6 mm Hg over two to three years, it is estimated that the risk reduces by14 per cent in patients with coronary heart disease and by 42 per cent in stroke patients (Collins et al 1990; Rose 1992.) When high blood pressure is controlled by medication, the risk of cardiovascular disease is reduced, but not to the levels of unaffected people.

In settings such as general practice where the monitoring of a person's health is ongoing and where a measure can change over time, the service contact date should be recorded.

DSS specific information:

In the primary care setting, blood pressure on both arms should be measured at the first visit, particularly if there is evidence of peripheral vascular disease.

Variation of up to 5 mm Hg in blood pressure between arms can be acceptable. In certain conditions (e.g. chronic aortic dissection, subclavian artery stenosis) all blood pressure recordings should be taken from the arm with the highest reading.

Measure sitting and standing blood pressures in elderly and diabetic patients or in other situations in which orthostatic hypotension might be suspected.

Measure and record heart rate and rhythm. Note: Atrial fibrillation in a patient with hypertension indicates increased risk of stroke.

In all patients, consideration should be given to obtaining blood pressure measurements outside the clinic setting either by self-measurement of blood pressure at home or by non-invasive ambulatory blood pressure monitoring.

Target-organ damage and cardiovascular outcome relate more closely to blood pressures measured outside the clinic, particularly with ambulatory monitoring. An accurate, reliable machine and technique are essential if home blood pressure monitoring is to be used. In up to 30% of patients who are hypertensive in the clinic, blood pressure outside the clinic is within acceptable limits ('white coat' hypertension).

High blood pressure is a major risk factor for coronary heart disease, heart failure, stroke, and renal failure with the risk increasing along with the level of blood pressure (Ashwell 1997; DHSH 1994b; Whelton 1994; Kannel 1991). The higher the blood pressure, the higher the risk of both stroke and coronary heart disease. The dividing line between normotension and hypertension is arbitrary.
Both systolic and diastolic blood pressures are predictors of heart, stroke and vascular disease at all ages (Kannel 1991), although diastolic blood pressure is a weaker predictor of death due to coronary heart disease (Neaton & Wentworth 1992).

The risk of disease increases as the level of blood pressure increases. When blood pressure is lowered by 4-6 mm Hg over two to three years, it is estimated that the risk reduces by14 per cent in patients with coronary heart disease and by 42 per cent in stroke patients (Collins et al 1990; Rose 1992.) When high blood pressure is controlled by medication, the risk of cardiovascular disease is reduced, but not to the levels of unaffected people.

In settings such as general practice where the monitoring of a person's health is ongoing and where a measure can change over time, the service contact date should be recorded.

DSS specific information:

The United Kingdom Prospective Diabetes Study (1987 to 1998) showed major benefit from lowering blood pressure in preventing diabetes complications.

A target for blood pressure for people who suffer from diabetes is 130/85 mm Hg or less; recommended by the Australian Diabetes Society (if proteinuria is detected it is less than 125/75 mm Hg) Australian Medicines Handbook: last modified February, 2001).

Following the NSW Principles of Care and Guidelines for the Clinical Management of Diabetes Mellitus for patients who suffer from hypertension, if pharmacological intervention is required, ACE inhibitors are the preferred agents for treating hypertension in people with diabetes (unless contraindicated).

DSS specific information:

The United Kingdom Prospective Diabetes Study (1987 to 1998) showed major benefit from lowering blood pressure in preventing diabetes complications.

A target for blood pressure for people who suffer from diabetes is 130/85 mm Hg or less; recommended by the Australian Diabetes Society (if proteinuria is detected it is less than 125/75 mm Hg) Australian Medicines Handbook: last modified February, 2001).

Following the NSW Principles of Care and Guidelines for the Clinical Management of Diabetes Mellitus for patients who suffer from hypertension, if pharmacological intervention is required, ACE inhibitors are the preferred agents for treating hypertension in people with diabetes (unless contraindicated).

High blood pressure is a major risk factor for coronary heart disease, heart failure, stroke, and renal failure with the risk increasing along with the level of blood pressure (Ashwell 1997; DHSH 1994b; Whelton 1994; Kannel 1991).