NICE publishes new guideline to improve care of patients with high blood pressure, UK

Main Category: Cardiovascular / Cardiology
Article Date: 27 Aug 2004 - 0:00 PST



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UK - The National Institute for Clinical Excellence (NICE) and the Newcastle Guideline Development and Research Unit (NGDRU) are today issuing a guideline on the diagnosis and management of hypertension (high blood pressure) in adults in primary care.

It is estimated that some 40 per cent of adults in England and Wales have hypertension and this proportion increases with age. The cost to the NHS of prescriptions for anti-hypertensives was around Ł840 million in 2001, nearly 15 per cent of the total annual cost of all primary care drugs. Hypertension is often inadequately treated and is a major contributory factor in cardiovascular diseases which account for 30 per cent of all deaths and four million bed days - or eight per cent of the total capacity of the NHS - annually.

Based on a thorough review of the evidence of clinical and cost-effectiveness in this area, the NICE guidelines will improve the accuracy of diagnosis and quality of care for people with hypertension. The guidelines emphasise the need for formal cardiovascular risk assessment for patients with high blood pressure who have not yet developed cardiovascular disease, so that other treatments to manage those at high risk can be considered alongside blood pressure lowering drugs.

Key recommendations highlighted in the guideline includes:

-- Measuring blood pressure: Patients with a single raised blood pressure reading of more than 140/90mmHg should be asked to return for a minimum of two subsequent clinics where their blood pressure can be measured using the best conditions available.

-- Cardiovascular risk: A formal cardiovascular risk assessment should be conducted in patients with hypertension to help identify diabetes, evidence of hypertensive damage to the heart and kidneys, and secondary causes of hypertension such as kidney disease.

-- Lifestyle interventions: Lifestyle advice (for example, smoking cessation, diet, alcohol and caffeine consumption, exercise) should be offered initially and then periodically to patients undergoing assessment or treatment for hypertension.

-- Pharmacological interventions: Drug therapy should be offered to:

- Patients with persistent high blood pressure of 160/100 mmHg or more

- Patients at raised cardiovascular risk (10-year risk of chronic heart disease >15% or cardiovascular disease >20% or existing cardiovascular disease or target organ damage) with persistent blood pressure of more than 140/90 mmHg.

- Drug therapy should normally begin with a low dose thiazide-type diuretic. If necessary at second line a beta-blocker should be added, unless the patient is at raised risk of new onset diabetes in which case an ACE-inhibitor should be added instead. At third line, a dihydropyridine calcium-channel blocker should be added.

-- Continuing treatment: Once blood pressure is managed adequately, an annual review of care should be provided to monitor blood pressure, provide support and discuss lifestyle, symptoms and medication. Patients without cardiovascular disease and with well-controlled blood pressure wishing to reduce or stop using drugs may be offered a trial reduction or withdrawal.

Andrew Dillon, NICE Chief Executive said: "The aim of this guideline is to decrease morbidity and mortality resulting from cardiovascular diseases such as stroke, chronic renal failure and coronary heart disease for which hypertension is a significant risk factor. Hypertension can be treated, in most cases, successfully. The fact that a significant proportion of people with this condition remain undiagnosed, coupled with evidence that suggests a high incidence of sub-optimal treatment - and therefore poor rates of blood pressure control - for those who are diagnosed, make this guideline particularly significant."

Professor Bryan Williams, Member of the Guideline Development Group and Professor of Medicine, University Hospitals NHS Trust, Leicester, said: "This is an important guideline because it has the potential to influence and improve the treatment of a huge proportion of the adult population of the UK. The NHS is making impressive progress in reducing cardiovascular disease and the effective detection and treatment of high blood pressure is fundamental to that objective."

Dr Wendy Ross, a GP and member of the Guideline Development Group, added: "Hypertension is one of the most important causes of heart attacks and strokes, and one that we can treat to reduce the risk of these. Primary care is where most patients with hypertension are diagnosed and treated. This guideline offers us clear guidance about whom to treat and how to go about it. It also clarifies the evidence for the benefits of effective treatment, which is important for people who may have been unaware of having any problem before their blood pressure was measured."

Colin Penney, Patient Representative sponsored by the Blood Pressure Association said: "The availability of a new countrywide guideline for the treatment of hypertension in adults has to be a major step forward. Only when consistency of approach is established can the benefit be evaluated and further improvements made. I hope that the most significant message that comes across from the guideline to patients and practitioners is that treatment is not simply a one-way process. Communication between both parties is essential in determining medication and realistic lifestyle interventions."

Ends

For further information or to arrange interviews please contact: Phil Ranson (NICE) on 020 7067 5904 / 0778 639 0068,

Notes to Editors:

About NICE

1. NICE is part of the NHS. It is the independent organisation responsible for providing national guidance on treatments and care for those using the NHS in England and Wales. Its guidance is for healthcare professionals and patients and their carers to help them make decisions about treatment and healthcare. For further information about NICE you can visit http://www.nice.org.uk.

2. NICE produces guidance in three areas of health:

-- the use of new and existing medicines and treatments within the NHS in England and Wales - technology appraisals

-- the appropriate treatment and care of patients with specific diseases and conditions within the NHS in England and Wales - clinical guidelines

-- whether interventional procedures used for diagnosis or treatment are safe enough and work well enough for routine use - interventional procedures. <-b>

NICE also funds three enquiries that undertake research into the way patients are treated to identify ways of improving the quality of care (the investigations are known as confidential enquiries).

3. NICE guidance and recommendations are prepared by independent groups that include professionals working in the NHS and people who are familiar with the issues affecting patients and carers.

About the clinical guideline on hypertension

4. The NICE guideline is available from http://www.nice.org.uk/CG018NICEguideline. The full version detailing the evidence base behind the recommendations is produced by the Newcastle Guideline Development and Research Unit at the University of Newcastle upon Tyne and is available on the NICE website. A version for the public is available from http://www.nice.org.uk/CG018publicinfo.

5. The guideline makes recommendations about measuring blood pressure, assessing cardiovascular risk, lifestyle interventions, pharmacological interventions and continuing treatment.

6. The guideline asks local health communities to review their existing management of the treatment of hypertension against this guideline. The review should consider the resources required to implement the recommendations set out in the guideline, the people and processes involved, and the timeline over which full implementation is envisaged. It is in the interests of patients that the implementation timeline is as rapid as possible. Relevant local clinical guidelines, care pathways and protocols should be reviewed in the light of this guidance and revised accordingly.

National Institute for Clinical Excellence (NICE)
City Place
71 High Holborn
London
WC1V 6NA
Tel: 020 7067 5800
Fax: 020 7067 5801
nice@nice.nhs.uk
http://www.nice.org.

Article adapted by Medical News Today from original press release.
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