Cookie policy: This site uses cookies (small files stored on your computer) to simplify and improve your experience of this website. Cookies are small text files stored on the device you are using to access this website. For more information please take a look at our terms and conditions. Some parts of the site may not work properly if you choose not to accept cookies.

Join

Subscribe or Register

Existing user? Login

Hypertension

NICE proposes lowering threshold for blood pressure treatment

Updated draft guidance on hypertension from the National Institute for Health and Care Excellence lowers the threshold for treatment to a diagnosis of stage 1 hypertension with an estimated 10-year risk of cardiovascular disease of 10% or more.

Blood pressure monitor

Source: Shutterstock.com

Around 450,000 men and 270,000 women in England have stage 1 hypertension and a cardiovascular disease risk of between 10% and 20%

Thousands more people could be eligible for blood pressure treatment under new National Institute for Health and Care Excellence (NICE) draft guidance.

The updated guideline on hypertension recommends reducing the threshold at which the treatment should be considered. It advises that blood-pressure-lowering drugs should be offered to people aged under 80 years with a diagnosis of stage 1 hypertension who have an estimated 10-year risk of cardiovascular disease (CVD) of 10% or more. Previously, the threshold was 20%.

It is estimated by NICE that around 450,000 men and 270,000 women in England would fall into the category of having stage 1 hypertension and a CVD risk of between 10% and 20%.

However, NICE said it was “difficult to predict what impact using the lower CVD risk threshold will have in practice” owing to variation in how its previous guidance, published in 2011, was being implemented. NICE estimated that around 50% of people above the 20% CVD risk threshold were currently receiving the blood pressure drugs.

Anthony Wierzbicki, chair of the NICE guideline committee, said: “A rigorous evaluation of new evidence has resulted in updated recommendations around when to treat raised blood pressure that have the potential to make a real difference to the lives of many thousands of people with the condition.

“The guideline effectively shifts the focus to earlier intervention with lifestyle or drug treatment because this may slow the age-related deterioration of blood pressure. This would keep people well for longer and reduce the long-term need for multiple medications.”

The draft guidance also “supports the ‘NHS Long Term Plan’s’ aim to improve chronic disease prevention” and places “a greater emphasis on achieving and maintaining blood pressure targets as many people with high blood pressure are undertreated”, he added.

NICE had previously said that it would “almost certainly” consider evidence used to produce American Heart Association guidance on hypertension diagnosis and management, published in November 2017, which reduced the blood pressure threshold for stage 1 hypertension.

But it said that although it did consider evidence “reviewed in other recent international hypertension guidelines”, they “were difficult to interpret because although they recruited people with raised blood pressure who had increased CVD risk, they also included people who had other CVD risk factors such as established blood pressure-related organ damage from previous CVD, or chronic kidney disease”.

“Therefore, these studies could not be directly used to inform the recommendations in this draft guidance,” NICE said.

Helen Stokes-Lampard, chair of the Royal College of GPs, said many GPs had concerns about overdiagnosis and the unintended harms of prescribing medication to groups of patients when the benefits may be limited.

“Lowering the threshold for treatment or diagnosis of hypertension, or high blood pressure — a condition that already affects a very large number of patients in the UK — is likely to affect thousands, if not millions of patients, so this decision must not be taken lightly and must be evidence-based,” she added.

A consultation on the draft guidance will close on 23 April 2019, and final guidance is expected to be published in August 2019. 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206267

Have your say

For commenting, please login or register as a user and agree to our Community Guidelines. You will be re-directed back to this page where you will have the ability to comment.

Recommended from Pharmaceutical Press

  • Integrated Pharmacy Case Studies

    Integrated Pharmacy Case Studies

    Over 90 case studies based on real life patient-care scenarios. Each case includes learning outcomes and references.

    £47.00Buy now
  • Pharmacy Registration Assessment Questions 2

    Pharmacy Registration Assessment Questions 2

    Pharmacy Registration Assessment Questions 2 features more than 400 entirely new, closed book and calculation questions. It can be used in conjunction with the previous volume or on its own. All questions are in line with current GPhC guidance, enabling you to prepare for the pharmaceutical pre-registration exam with confidence.

    £35.00Buy now
  • Introducing Palliative Care (IPC 5)

    Introducing Palliative Care (IPC 5)

    A key resource for students, covering the recommended palliative curriculum for medical undergraduates.

    £25.00Buy now
  • Essentials of Nonprescription Medications and Devices

    Essentials of Nonprescription Medications and Devices

    Essentials of Nonprescription Medications and Devices provides a quick, comprehensive reference of products available for self-care.

    £33.00Buy now
  • Drugs and the Liver

    Drugs and the Liver

    Drugs and the Liver assists practitioners in making pragmatic choices for their patients. It enables you to assess liver function and covers the principles of drug use in liver disease.

    £38.00Buy now

Search an extensive range of the world’s most trusted resources

Powered by MedicinesComplete
  • Print
  • Share
  • Comment
  • Save
  • Print Friendly Version of this pagePrint Get a PDF version of this webpagePDF

Jobs you might like

Newsletter Sign-up

Want to keep up with the latest news, comment and CPD articles in pharmacy and science? Subscribe to our free alerts.