Updated NICE hypertension guidance halves threshold for prescribing antihypertensives

GPs should offer BP-lowering drugs to patients under 80 years with stage 1 hypertension who have an estimated 10-year CVD risk of 10% or more, revised NICE guidance recommends.

Stage 1 hypertension is defined as a clinic BP ranging from 140/90mmHg to 159/99mmHg and subsequent ABPM or HBPM average BP ranging from 135/85mmHg to 149/94mmHg. | GETTY IMAGES
Stage 1 hypertension is defined as a clinic BP ranging from 140/90mmHg to 159/99mmHg and subsequent ABPM or HBPM average BP ranging from 135/85mmHg to 149/94mmHg. | GETTY IMAGES

Antihypertensive treatment was previously recommended by NICE for patients with stage 1 hypertension and an estimated 10-year CVD risk of 20%. NICE called the halving of this threshold the 'biggest change' to its advice on the diagnosis and management of hypertension in adults since 2011.

Around 450,000 men and 270,000 women fall into the 10–20% risk range according to NICE, although estimates suggest half of these people may already be receiving antihypertensive treatment.

'Missed opportunity'

President of the British and Irish Hypertension Society (BIHS) Professor Francesco P Cappuccio, professor of cardiovascular medicine at the University of Warwick, welcomed the new guidance but questioned the exclusion of patients with established CVD (including prior myocardial infarction, stroke and heart failure).

Professor Cappuccio said: 'The latter group represents up to one third of patients with hypertension seen daily in primary and secondary care'.

He added: 'Ninety-seven percent are treated for hypertension, and only 6 out of 10 have it controlled to target. To them the guideline does not apply. This is not only a missed opportunity to improve the management of hypertension in people with the highest risk, but a challenge for the implementation of the guideline in primary care.'

Earlier intervention

High BP affects around 13.5 million people in England and contributed to around 75,000 deaths in 2015. Clinical management of hypertension accounts for 12% of visits to primary care and up to £2.1 billion of healthcare costs, NICE said.

Anthony Wierzbicki, consultant in metabolic medicine/chemical pathology and chair of the guideline committee, has said of the updated guidance: '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.

'It unifies and simplifies the advice given to GPs in implementing the NHS health check and it supports the NHS long-term plan's aim to improve chronic disease prevention. The guideline also places a greater emphasis on achieving and maintaining blood pressure targets as many people with high blood pressure are undertreated.'

The quick-reference MIMS summary of the guidance has been updated to reflect the new advice.

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