New draft guideline on hypertension needs careful consideration, says College

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 CVD risk, such as chronic kidney disease. Therefore, these studies could not be directly used to inform the recommendations in this draft guidance.

Anthony Wierzbicki, Consultant in metabolic medicine/chemical pathology and chair of the guideline committee, said: “Many people with high blood pressure don’t actually know they have it because it rarely causes any noticeable symptoms. However, it is by far the biggest preventable cause of death and disability in the UK through strokes, heart attacks and heart failure. 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.”

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, has responded to a new NICE draft guideline on the diagnosis and treatment of hypertension. 

She said: “Taking steps to prevent cardiovascular disease in patients is vital to help safeguard their long-term health and wellbeing, and it is a key pledge in the NHS long-term plan. But many GPs do also have 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.

“Clinical guidelines are regularly updated to take into account the most current research and make recommendations of how to implement it in the best interests of patients. Now that this draft guideline is open for consultation, we would encourage experts in the area to respond to express their views.

“We know that weight control, careful diet, and better exercise habits all remain key ways to prevent or reduce hypertension. GPs already advocate healthy lifestyle changes and discuss these with their patients where possible within the constraints of a standard 10-minute appointment.

“Patients should be aware that while clinical guidelines are very useful for GPs when developing treatment plans, they are not tramlines forcing us to practise in certain ways. GPs are highly-trained to prescribe taking into account the guidelines but also the circumstances of the individual patient sitting in front of them, including physical, physiological and social factors that might be affecting their health.”