NICE has published its draft updated guideline on the diagnosis and treatment of high blood pressure (hypertension) for public consultation.
In the biggest change to NICE’s previous guidance published in 2011, the level of a person’s cardiovascular disease risk at which treatment for high blood pressure can be started has been reduced.
The draft guideline recommends that blood pressure lowering drugs should be offered to people aged under 80 with a diagnosis of stage 1 hypertension who have a 10% or greater risk of developing cardiovascular disease within the next 10 years.
It is estimated that around 450,000 men and 270,000 women would fall into this category. However, it is likely that the impact of the new recommendations will in fact be lower as some estimates suggest half of people in this category are already receiving treatment.
The draft guideline also considered new studies suggesting people with blood pressure below the level at which high blood pressure is usually diagnosed (140/90mmHg) might also benefit from medication. It also looked at what the effect would be of lowering the blood pressure target for people on treatment. However, some of these studies, which formed a key part of the evidence reviewed in other recent international hypertension guidelines, were difficult to interpret because they included people who had other conditions that would also raise their cardiovascular disease risk, such as chronic kidney disease. Therefore, these studies could not be directly used to inform the recommendations in this draft guidance.
In 2015 high blood pressure affected more than 1 in 4 adults (31% of men; 26% of women) – around 13.5 million people – and contributed to 75,000 deaths in England. The clinical management of hypertension accounts for 12% of visits to primary care and up to £2.1 billion of healthcare expenditure.
Over the last decade progress has been made to improve the diagnosis and management of hypertension: the average blood pressure in England has fallen by about 3 mmHg systolic and the proportion of adults with untreated high blood pressure has decreased. However, the Public Health England Blood Pressure Action Plan (Tackling high blood pressure: from evidence into action, 2015) called for further measures to reduce average blood pressure by a further 5 mmHg through improved prevention, detection and management.
The draft guideline supports the direction of the NHS Long Term Plan and CVD ambitions to improve outcomes in cardiovascular disease, including preventing strokes and heart attacks, through better detection and treatment of high blood pressure.
The draft guideline is open for public consultation until 23 April 2019. Final guidance is expected to be published in August 2019.
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NICE information on draft hypertension guidelines
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