This podcast makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this video I will go through a real-life case of a young woman with hypertension. It will focus on the NICE guidance on Hypertension in pregnancy: diagnosis and management addressing issues relevant to Primary Care only. I am not giving medical advice; this video is intended for health care professionals; it is only my interpretation of the guidelines and you must use your clinical judgement.   There is a YouTube version of this and other videos that you can access here:  The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The link to the PDF version of this episode can be downloaded here:   ·      https://1drv.ms/b/s!AiVFJ_Uoigq0mEqfJs8aMAUqULYy?e=wDydMJ   The visual summary- pre-pregnancy advice can be downloaded here:   ·      https://1drv.ms/b/s!AiVFJ_Uoigq0mEsJdGIU4F7fR9MF?e=7nTS0f The Full NICE guideline Hypertension in pregnancy: diagnosis and management [NG133] can be found at: ·      https://www.nice.org.uk/guidance/ng133/chapter/Recommendations  Thumbnail photo: ·      Image by rawpixel.com on Freepik ·      a href="https://www.freepik.com/free-photo/confident-african-businesswoman-smiling-closeup-portrait-jobs-career-campaign_18836358.htm#query=YOUNG%20BLACK%20WOMAN&position=14&from_view=search&track=ais"Image by rawpixel.com/a on Freepik  Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release]    Music provided by Audio Library Plus    Watch: https://youtu.be/aBGk6aJM3IU   Free Download / Stream: https://alplus.io/halfway-through Transcript Hello and welcome, I am Fernando, a GP in the UK. Today, we will go through a real-life case of a young woman with hypertension. We will focus on the NICE guidance addressing issues relevant to Primary Care only.  So let’s jump into it. Maria is a 31-year-old woman of mixed Afro-Caribbean family origin. She has hypertension and, because of her young age, she has been fully investigated for secondary causes and her diagnosis is essential hypertension. Her medication is amlodipine 10 mg daily and she is otherwise fit and healthy. Her blood pressure is 155/92 mmHg. What should we do? She is on step 1 treatment with 1 drug, in this case the maximum dose of amlodipine, a calcium channel blocker, which is the preferred choice for people who do not have diabetes and who are of Afro-Caribbean background. NICE says that if the BP is not controlled with a CCB alone, we have to start step 2 treatment with two drugs adding either: ·      an ACE inhibitor or an ARB, and if the person is of Afro-Caribbean background an ARB should be used in preference to an ACE inhibitor ·      or alternatively we can prescribe a thiazide-like diuretic So, our instinct will probably tell us to start an ARB, something like, for example, losartan 25 mg daily and titrate it up according to response. This seems to be fairly straightforward so far. But then she tells you: doctor, I am actively trying to get pregnant. Is that going to be OK? And obviously, it will not be OK. In fact, we should have thought about it even before she mentioned it because, being a woman of childbearing age, it is a possibility that we must always bear in mind. And this is where we need to look at the NICE guideline: Hypertension in pregnancy: diagnosis and management which was last updated in April 2023 and which not only covers hypertension during pregnancy, but also includes advice for women with hypertension who wish to conceive. We know that ACE inhibitors and ARBs