The same blood pressure targets should be used in people with and without CVD, NICE has said in a review of its guideline on the diagnosis and management of hypertension. The quick-reference MIMS summary of the guideline has been updated to reflect the new recommendations.
The updated guidance also includes a new recommendation on antihypertensive treatment for people with CVD. In this group, NICE says healthcare professionals should follow the recommendations for disease-specific indications in the NICE guideline on their condition (for example, when prescribing an ACE inhibitor or an angiotensin II antagonist for secondary prevention of myocardial infarction).
If their blood pressure remains uncontrolled, antihypertensive treatment should be offered in line with the existing recommendations in the guideline.
The guideline committee noted that the recommendation reflects current practice for most types of CVD. They acknowledged that, after a stroke, the thiazide-like diuretic indapamide is sometimes used first, rather than a calcium channel blocker. However, it is unclear how common this is. As people with CVD are commonly prescribed more than 1 antihypertensive drug, it is thought any impact on prescribing would be limited.
The recommendation regarding blood pressure targets for patients with CVD also reflects current practice for most types of CVD, so NICE says there should be no change in practice or increase in resource use. The Royal College of Physicians Intercollegiate Stroke Working Party guideline recommends a lower target for people after stroke. However, the national quality indicators used in primary care do not use a lower target for people with CVD, including stroke and transient ischaemic attack.