Newsletter - Spring 2002 edition

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Dear Colleague

Spring time is here so it is an ideal opportunity to dust off our abstracts and get them ready for our Scientific meeting at Kings' College, University of Cambridge 9-11th September 2002.

2002 is a very exciting year for the NHA, in particular, the NSF for Cardiovascular disease has now been ratified which makes Hypertension much more of a predominant problem in terms of national targets. So what are you doing locally? Please write and let me know.

We are also eagerly awaiting the Diabetes NSF, due out in summer 2002, although we have the Standards, which were released in December 2001. These obviously inter-disperse with hypertension and both together in terms of long-term management of patients will be very exciting for us as members of the NHA. The Diabetes NSF Standards are attached along with this newsletter

Please keep those articles rolling in and ensure that I am updated with any new events in your areas, usual address at the end of this newsletter.

Best wishes,
Bernie Stribling
Chair, Nurses Hypertension Association

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Drug treatment of mild to moderate hypertension in pregnancy

From - Sally Brett

Hypertensive disorders complicate approximately 7 - 15% of pregnancies (1,2). In general mild to moderate hypertension in pregnancy reflects a DBP between 90 - 109 mmHg (1,2). It is readily treated with drugs but all anti-hypertensive agents can cross the placenta and therefore may have adverse effects on the foetus, therefore it is important to chose anti-hypertensive agents carefully.

METHYLDOPA is the most widely prescribed anti-hypertensive for mild to moderate hypertension in pregnancy in the UK (1). It has the best documented maternal and safety record including long term paediatric follow up data (2). It does not alter maternal cardiac output or blood flow to the uterus or kidneys.
LABETOLOL, a combined ( and (-adrenoreceptor blocker is a peripheral vasodilator and effective in pre-eclamptic and non-proteinuric hypertension in pregnancy. The anti-hypertensive effect is not associated with compromised renal or uterine blood flow (2). The safety record of labetolol in pregnancy is not as well established as that of methyldopa. However in a randomised comparative study of 263 pregnant women with mild to moderate hypertension treatment with either labetolol or methyldopa achieved significantly lower maternal blood pressures throughout gestation compared with no medication. There were no differences between the 3 groups with respect to gestational age at delivery, birthweight and foetal growth retardation (3).
NIFEDIPINE (LA only) has been the most extensively studied of the CALCIUM ANTAGONISTS and has been shown to reduce maternal blood pressure in women with mild to moderate hypertension without apparent adverse effects on the foetus. Little is known about the effects of the long term administration of the other calcium antagonists (1,2).
HYDRALAZINE is a direct vasodilator, which often requires combination therapy with methyldopa or a (-blocker in the long term management of chronic hypertension in pregnancy. It appears to be reasonably safe for the foetus although a few cases of foetal thrombocytopenia have been reported (2). However in the UK it is established, along with nifedipine LA, as an effective and well tolerated anti-hypertensive agent in pregnancy.
(-BLOCKERS are not generally used as first line treatment for mild to moderate hypertension during pregnancy in the UK. When used for short periods during the third trimester they appear effective and well tolerated provided there are no signs of interuterine growth impairment. The cardioselective (-blocker ATENOLOL, however, has been shown to result in significantly lower birthweights compared with placebo and other anti-hypertensive agents and this effect may be related to duration of therapy (4,5,6).
AVOID ACE INHIBITORS. During the second and third trimesters ACE inhibitors can result in a number of adverse effects on the foetus including growth retardation, renal failure, persistent ductus arteriosus, respiratory distress syndrome, foetal hypotensive syndrome and prepartum death (7). Although ACE inhibitors may be safe in early pregnancy there are possible risks and women should be advised to discontinue ACE inhibitors before or when they become pregnant. As the teratogenic risk is thought to be related to the pharmacological effect of the drugs on foetal physiology, angiotensin II receptor antagonists are also not recommended (1,2).
AVOID DIURETICS as antihypertensives during pregnancy as they may reduce maternal plasma volume and can cause electrolyte disturbances (2).

References

Magee LA. Treating hypertension in women of child bearing age and during pregnancy. Drug safety 2001; 24 (6): 457-474
Khedun SM et al. Effects of antihypertensive drugs on the unborn child. What is known, and how should this influence prescribing? Paediatr Drugs 2000; 2(6): 419 - 436
Sibai BA et al. A comparison of no medication versus methyldopa or labetolol in chronic hypertension during pregnancy. Am J Obstet Gynaecol. 1990; 162: 960-967
Butters L et al Atenolol in essential hypertension in pregnancy. BMJ 1990; 301: 587-589
Lip GYH et al Effect of atenolol on birth weight. Am J Cardiol 1997;79: 1436-1438
Lydakis C et al Atenolol and fetal growth in pregnancies complicated by hypertension. Am J Hypertens 1999;12:541-547
Buttar HS. An overview of the influence of ACE inhibitors on fetal placental circulation and perinatal development. Mol Cell Biol 1997;176 (1-2):61-71

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Member Profile - Joan Curzio

Joan, a founding member of the NHA, has recently been appointed as the Professor of Practice Development in the Faculty of Health at South Bank University.

She is based at their Essex campus at Harold Wood Hospital and will be working with the faculty and the local acute and community based trusts. Previously, Joan was a Project Leader with the Nursing Research Initiative for Scotland a Scottish Chief Scientist Office funded research unit based at Glasgow Caledonian University (1995-2002) and was a nurse researcher in the Department of Medicine and Therapeutics at Glasgow University (1981-1995).

Although now dealing with issues frequently at a more strategic and policy level in nursing and health in general, her specialist research interests continue and include hypertension, blood pressure measurement, cardiovascular disease in general, getting evidence into practice and the role nurses play in health care.

She received her BSc and MSc degrees (both in Nursing) from California State University at Long Beach and obtained her PhD in 1994 from the University of Glasgow. The title of her thesis is Strategies for hypertension and multiple risk factor follow-up care. Joan has also been Scientific Secretary (1992-1994) as well as Vice-Chairman, Chairman Elect (1994-1996), and Chairman (1996-1998) of the NHA.

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Finance, money and membership - A plea from the secretary

It is time once again to renew your membership and this must be done before the 1st May to enable you to attend the September Scientific Meeting. Please could you also complete the accompanying slip with your contact details and it would be extremely handy if you could send me an email address - thank you, Sally Armstrong.

There is discussion about increasing the subscription by £10 annually, this is in recognition that all of our members are now going to receive a free monthly copy of the British Cardiology Journal and I hope this is well received.

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Websites to check out

Check out www.medscape.com. This website contains a wealth of interesting articles, papers and reviews. It is free to register and has dedicated pages for nurses. In addition you can personalise the site with your own speciality or area of interest, or just have a browse around.

I am sure that a lot of you are aware of it but for those that are not…

Also very popular for searching for references is the National Library of Medicine PubMed site.

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Free mugs & mousemats!

Even though there has been a slight demand for these, quite a number still exist, so please if you want to receive yours, send us an email with your contact details.

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Courses

Are you running a training session in hypertension? Do you want to let others know? Tell me and it will appear in big print in the newsletter.

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Committee members for 2002

A number of positions are due to become vacant in September 2002. If you are interested in any position whatsoever please write and let me know.

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Finance & funding

The NHA has been going from strength to strength over a number of years, however this has been down to the good fortune and good financial management of the team involved. However, this year in particular we have been financially struck and it is now proving more and more difficult, as nurses, to have a separate meeting from the BHS although in collaboration with them. I would appreciate your views on the future of the NHA and where you feel it should be going as it is now proving more difficult in terms of long-term funding.

Drug companies are not particularly keen to spend lots of money in terms of supporting the scientific meeting, and therefore perhaps we need to think about being more creative in terms of financial management. I really would appreciate your views and these can be emailed to me. What I would really like to hear from you is whether or not you feel that the NHA, as an organisation, needs to continue, or whether or not it needs to merge with the BHS.

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Abstracts

Please, please, please can we have abstracts for the Scientific meeting. Don't forget it can be work in progress, it can be a scientific study, it can be whatever is going on in your area currently. We really would like to hear from you so that as nurses we can present at the Scientific Meeting. Also attached with the newsletter is an abstract form, so please don't forget to return it by 3rd May to Sally Brett, Scientific Secretary. There is also a prize for the best abstract, and this year we are going to offer return travel to Paris via Eurostar!

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Dates for your diary

Queen's College Cambridge - 9-11th September 2002 - Annual Scientific Meeting

St Johns College Cambridge - 15-17th September 2003 - Annual Scientific Meeting

Contact Details
Bernie Stribling, Chair
Nurses Hypertension Association
Management Office
Level 6, Windsor Building
Leicester Royal Infirmary
University Hospitals of Leicester NHS Trust
Infirmary Square
Leicester
LE1 5WW

Tel: 0116 258 5971
PA, Meg: 0116 258 5394
Email: Bernie.Stribling@uhl-tr.nhs.uk

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Diabetes - NSF standards

Standard 1 Prevention of type 2 diabetes
Standard 2 Identification of people with diabetes
Standard 3 Empowering people with diabetes
Standard 4 Clinical care of adults with diabetes
Standards 5&6 Clinical care of children and young people with diabetes
Standard 7 Management of diabetic emergencies
Standard 8 Care of people with diabetes during admission to hospital
Standard 9 Diabetes and pregnancy
Standards 10 Direction and management of long term complications