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Hypertension

NICE to consider same evidence as American Heart Association as part of hypertension guideline review

If NICE follows United States guidelines, many UK patients usually treated with lifestyle changes will be prescribed medicine to cut risk of heart attack and stroke.

Taking someone's blood pressure

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The National Institute for Health and Care Excellence will review its hypertension guidelines, the changes in which may affect the threshold between stage one and stage two hypertension

The National Institute for Health and Care Excellence (NICE) is updating its advice on the diagnosis and management of hypertension and will “almost certainly” consider evidence used to produce new American Heart Association guidance as part of its review.

NICE expects to publish its revision of the 2011 guideline in August 2019 with consultation on draft recommendations due to take place early in 2019. The update will consider blood pressure or cardiovascular disease risk threshold should anti-hypertensive treatment be initiated, and whether the use of targets improves outcomes for adults with treated primary hypertension.

The organisation said it will also be consulting on whether these targets should be based on blood pressure or cardiovascular risk, and the optimum blood pressure or cardiovascular risk targets for adults with treated primary hypertension.

A spokesperson for NICE said: “Our advisory committee will follow the evidence and apply our normal process for making their recommendations, which takes into account costs and benefits and which will be subject to consultation in due course.

“We have not speculated about how many people, if any, might be or might not be classed as hypertensive or offered anti-hypertensives because we are only just beginning the process of considering the evidence.”

They added: “We will almost certainly be considering some of the same evidence as the United States guideline developers.”

Guidelines published by the American College of Cardiology (ACA) and American Heart Association (AHA) in November 2017 decreased the threshold for stage one hypertension from an average systolic blood pressure of 140mmHg to 130mmHg, and from ≥160mmHg to ≥140mmHg for stage two.

Current NICE guidelines define stage one hypertension as an average blood pressure of 135/85mmHg or higher, and stage two as 150/95mmHg or higher. It advises that doctors should “offer antihypertensive drug treatment to people of any age with stage two hypertension”.

 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2018.20204552

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