Preventive activities in general practice 7th edition

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Screening tests of unproven benefit

Appendices

Disclaimer

Blood pressure

Blood pressure age range table
Age	0 - 9	10 - 14	15 - 19	20 - 24	25 - 29	30 - 34	35 - 39	40 - 44	45 - 49	50 - 54	55 - 59	60 - 64	65 - 69	70 - 79	>80
			17	X	X	X	X	X	X	X	X	X	X	X	X

Blood pressure age range table

Age

0 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 - 69

70 - 79

>80

Blood pressure should be measured in all adults from 18 years of age at least every 2 years (A). The risk of CVD is continuous across a range of BPs and thus the benefit of lowering BP should be considered in all patients.³¹³ In patients aged 45–74 years, this should be decided according to their absolute cardiovascular risk (B).

Blood pressure: Risk
Who is at higher risk of vascular disease?	What should be done?	How often?	Level of evidence and references
Average risk Adults 18–50 years of age (dependent on risk factors identified through absolute cardiovascular CV risk assessment)	Measure BP	Every 2 years if systolic BP (SBP) <120 mmHg and diastolic BP (DBP) <80 mmHg	I A 314
Increased risk 10–15% absolute CV risk Age 75+ years High normal BP 120–139/80–89 Age >50 years Diabetes at <60 years Aboriginal people, Torres Strait Islanders, South Asians and Maori and Pacific Islanders from 15 years of age	Measure BP Lifestyle risk factor counselling	Every 12 months	II A 314,315
High risk >15% absolute CV risk BP >180/110 or diabetes at age >60 years or microalbuminuria Moderate or severe chronic kidney disease Familial hypercholesterolaemia First degree relative (ie. father, mother, sibling) who has had a vascular event or condition diagnosed <60 years of age SBP ≥180 mmHg or DBP ≥110 mmHg Serum total cholesterol >7.5 mmol/L	Measure BP Lifestyle risk factor counselling Pharmacotherapy to lower risk	Every 6 months	I A 313
316,317
High risk Existing CVD (previous event, atrial fibrillation, symptomatic CVD)	Measure BP Lifestyle risk factor counselling Pharmacotherapy to lower risk	Every 6 months	313

Blood pressure: Risk

Who is at higher risk of vascular disease?

What should be done?

How often?

Level of evidence and references

Average risk

Adults 18–50 years of age (dependent on risk factors identified through absolute cardiovascular CV risk assessment)

Measure BP

Every 2 years if systolic BP (SBP) <120 mmHg and diastolic BP (DBP) <80 mmHg

I A 314

Increased risk

10–15% absolute CV risk
Age 75+ years
High normal BP 120–139/80–89
Age >50 years
Diabetes at <60 years
Aboriginal people, Torres Strait Islanders, South Asians and Maori and Pacific Islanders from 15 years of age

Measure BP

Lifestyle risk factor counselling

Every 12 months

II A 314,315

High risk

>15% absolute CV risk
BP >180/110 or diabetes at age >60 years or microalbuminuria
Moderate or severe chronic kidney disease
Familial hypercholesterolaemia
First degree relative (ie. father, mother, sibling) who has had a vascular event or condition diagnosed <60 years of age
SBP ≥180 mmHg or DBP ≥110 mmHg
Serum total cholesterol >7.5 mmol/L

Measure BP

Lifestyle risk factor counselling

Pharmacotherapy to lower risk

Every 6 months

I A 313

316,317

High risk

Existing CVD (previous event, atrial fibrillation, symptomatic CVD)

Measure BP

Lifestyle risk factor counselling

Pharmacotherapy to lower risk

Every 6 months

313

Blood pressure intervention
Intervention	Technique	References
Measure BP	Measure BP on at least two separate occasions with a calibrated mercury sphygmomanometer (regularly calibrate your instrument against a mercury sphygmomanometer). At the patient‘s first BP assessment, measure BP on both arms. Thereafter, use the arm with the higher reading If possible, use ambulatory BP monitoring or self measurement for patients with any of the following: unusual variation between BP readings in the clinic suspected white coat hypertension (eg. clinic hypertension, low CV risk and absence of target organ disease) hypertension resistant to drug treatment suspected hypotensive episodes (eg. in elderly or diabetic patients)	313
Lifestyle	Nonpharmacological therapies such as reduction in dietary sodium intake, increased physical activity, weight loss, stress management, and reduction in alcohol intake are associated with a reduction in BP	54

Blood pressure intervention

Intervention

Technique

References

Measure BP

Measure BP on at least two separate occasions with a calibrated mercury sphygmomanometer (regularly calibrate your instrument against a mercury sphygmomanometer). At the patient‘s first BP assessment, measure BP on both arms. Thereafter, use the arm with the higher reading

If possible, use ambulatory BP monitoring or self measurement for patients with any of the following:

unusual variation between BP readings in the clinic
suspected white coat hypertension (eg. clinic hypertension, low CV risk and absence of target organ disease)
hypertension resistant to drug treatment
suspected hypotensive episodes (eg. in elderly or diabetic patients)

313

Lifestyle

Nonpharmacological therapies such as reduction in dietary sodium intake, increased physical activity, weight loss, stress management, and reduction in alcohol intake are associated with a reduction in BP

Guide to follow up of adults 18 years and over

Guide to follow up of adults 18 years and over
Systolic (mmHg)	Diastolic (mmHg)	Follow up
<120 120–139 140–159 160–179 ≥180	<80 80–89 90–99 100–109 ≥110	Recheck in 2 years (or earlier as guided by patient’s absolute CV risk) Recheck in 1 year (or earlier as guided by patient’s absolute CV risk) Confirm within 2 months* Re-assess or refer within 1 month* Re-assess or refer within 1–7 days as necessary*
Isolated systolic hypertension
≥140 ≥160	<90 <70	As for category for systolic BP Re-assess or refer within 1–7 days as necessary*
If systolic and diastolic categories are different, follow recommendations for shorter follow up (eg. BP 160/86 mmHg evaluate or refer within 1 month) * See NHFA Guide to management of hypertension, 2008 Adapted from: Heart Foundation. Hypertension management guidelines for doctors, 2008³¹³

Systolic (mmHg)

Diastolic (mmHg)

Follow up

<120
120–139
140–159
160–179
≥180

<80
80–89
90–99
100–109
≥110

Recheck in 2 years (or earlier as guided by patient’s absolute CV risk)
Recheck in 1 year (or earlier as guided by patient’s absolute CV risk)
Confirm within 2 months*
Re-assess or refer within 1 month*
Re-assess or refer within 1–7 days as necessary*

Isolated systolic hypertension

≥140
≥160

<90
<70

As for category for systolic BP
Re-assess or refer within 1–7 days as necessary*

If systolic and diastolic categories are different, follow recommendations for shorter follow up (eg. BP 160/86 mmHg evaluate or refer within 1 month)
* See NHFA Guide to management of hypertension, 2008
Adapted from: Heart Foundation. Hypertension management guidelines for doctors, 2008³¹³

Guidelines for preventive activities in general practice 7th edition

Full index

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Oral hygiene

Glaucoma

Urinary incontinence

Osteoporosis

Screening tests of unproven benefit

References

Appendices

Glossary

Acronyms

Acknowledgements

Disclaimer

Blood pressure

Guide to follow up of adults 18 years and over