Making general practitioner’s work easier by means of the foramlized Czech hypertension quidelines

Authors: J. Peleška
Authors‘ workplace: 3. interní klinika 1. LF a VFN, Praha ;  Centrum biomedicínské informatiky, Ústav informatiky AV ČR, v. v. i., Praha ;  Ředitelka: prof. RNDr. Jana Zvárová, DrSc. ;  Přednosta: prof. MUDr. Štěpán Svačina, DrSc., MBA
Published in: Prakt. Lék. 2009; 89(7): 382-388
Category: Of different specialties


Simplification of diagnostic and treatment procedures in frame of the current hypertension guidelines for primary care (GL) and simultaneous using a transferable experience of a hypertension specialist should save time. A GP should use the saved time to improve communication with a patient to achieve his (her) more intensive cooperation in diagnostics and treatment for hypertension. This means mainly home blood pressure measurement.

Within 3 months (at maximum) every hypertensive (those with low cardiovascular risk included) is to start pharmacotherapy using drugs with the highest protection against organ damage and evidence – ACE-inhibitors. If they are not tolerated, it is necessary to change them for angiotensin II receptor type 1 blockers (ARB).

Calcium channel blockers (CCB) are suitable as the second drug into combination therapy. CCB and the previous two drug classes are also the best-tolerated ones.

The third drug for a triple therapy should be a thiazide diuretic in a small dose, if need be substituted with indapamide or metipamide.

Due to a deficit in hypertension control it is more realistic to achieve at least the usual goal BP values in most hypertensives and to treat them simultaneously for other associated risk factors dyslipidemia and diabetes.

The formalization of GL by means of the graphic GLIF model could help to improve the control of hypertension. Besides depicting the logical structure of GL decision algorithm it enables an easy calculation of the total cardiovascular risk according to the SCORE project, evaluation of the recommended subclinical organ damages and quick finding of a suitable monotherapy and combination therapy based on entered data of a patient.

Key words:
hypertension control in primary care, hypertension guidelines, algorithm of hypertension specialist, home BP measurement


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