NICE consultation

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Blood Pressure Association comment on NICE consultation on new guidance for diagnosing and treating high blood pressure
22/02/2011

The National Institute for Health and Clinical Excellence (NICE) today started a consultation period with stakeholders on new guidelines for diagnosing and treating high blood pressure. This is a consultation and so the final guidance may change.

NICE released a statement that states ‘In one of the biggest changes to NICE’s original guidance, published in 2004, the draft guideline recommends that a diagnosis of primary hypertension should be confirmed using 24-hour ambulatory blood pressure monitoring (ABPM), or home blood pressure monitoring (HBPM), rather than be based solely on measurements of blood pressure taken in the clinic’.

Professor Gareth Beevers, Trustee of the Blood Pressure Association says “The Blood Pressure Association welcomes the proposals put forward for consultation on new guidelines for diagnosing and treating high blood pressure by NICE. Taking account of Ambulatory and home blood pressure readings in the diagnosis of hypertension should mean doctors have a better picture of a patient’s blood pressure in a non-clinical setting. This should aid correct diagnosis and treatment and mitigate against ‘white coat hypertension’. The Blood Pressure Association has recommended patients take their blood pressure at home for a number of years now, though it’s essential that the blood pressure monitor has been clinically validated (for a list of clinically validated monitors, click here).

It will be interesting to see the extent to which the new guidance looks at family history and the results from an ECG in the diagnosis.”

NICE state the draft recommendations include:

  • If the first and second blood pressure measurements taken during a consultation are both higher than 140/90mmHg, offer 24-hour ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension
  • Offer antihypertensive treatment to people with stage 2 hypertension, (that is, initial clinic systolic blood pressure exceeds >/ 160 mmHg and or diastolic blood pressure >/ 100 mmHg and subsequent ABPM daytime average or HBPM average of 150/ 95 mmHg or higher.
  • Offer antihypertensive drug treatment to people with stage 1 hypertension (that is initial clinic systolic blood pressure of 140/ 90 mmHg or higher and subsequent ABPM daytime average of HBPM average of 135/85 mmHG or higher) who have:

- Target organ damage or
        - Established cardiovascular disease or
        - Renal disease or
        - Diabetes or
        - A 10-year cardiovascular risk equivalent to 20% or greater.    

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