NICE release draft update of blood pressure guidelines

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NICE release draft update of blood pressure guidelines
03/04/2019

UK health experts release draft guidelines making blood pressure medicines more available for people with a lower risk of heart disease 

The health experts at the National Institute for Health and Care Excellence (NICE) have released a draft of their updated guidance for health professionals who treat high blood pressure. The draft includes a number of changes to diagnosis and treatment. Most significantly, it recommends that blood pressure medicines be offered to people with stage 1 hypertension who have a 10% risk of developing diseases of the heart and blood vessels in the next 10 years, rather than a 20% risk. Although this sounds like a big change, in fact it will not dramatically effect blood pressure treatment.

Stage 1 hypertension is blood pressure of 140/90mmHg or over. To calculate a person’s overall risk of illness, GPs consider not only their blood pressure numbers, but other aspects of their health as well, including weight, age, family history, smoking and drinking alcohol for example. 

NICE estimated that around 450,000 men and 270,000 women would fall into this category and could now be offered medicines. But they noted that in reality many in this category could already be receiving them. 

The aim of the change is to prevent the unnecessary heart attacks and strokes caused by high blood pressure by offering treatment at an earlier stage. 

Anthony Wierzbicki, chairman of the NICE guideline committee, said: “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.”

Nirmala Markandu, Hypertension Nurse Specialist at Blood Pressure UK adds:Some health professionals have expressed concern about relying more on medications and the problem of over-medication. But the change in guidelines also highlights the need for professionals in various fields to tackle high blood pressure before it becomes a problem, with free blood pressure checks, healthy living advice and practical support, as well as providing medicines when suitable.”

The cut-off point for diagnosing high blood pressure has not changed 

The update in the treatment guidelines comes a year after health authorities in America lowered the cut off point for diagnosing and treating high blood pressure from 140/90mmHg to 130/80mmHg. This was based on evidence showing that lowering high blood pressure below the current target of 140mmHg saves lives. For example, 2016’s SPRINT Trial showed that lowering blood pressure to a target of 120mmHg instead of 140mmHg lowered the number of strokes and heart attacks and heart failure.

The new draft UK guidelines have not lowered the treatment cut-off point of 140/90mmHg – instead they considered the overall risk of developing a heart attack or stroke as the key factor in making treatment decisions. But they did note that some people with blood pressure lower than this could benefit from medicines. 

We’ll be giving our expert opinion

The guidelines were last updated in 2011, and the new update of Hypertension in adults: diagnosis and management, is due to be published formally in August this year. The new draft guidelines were released in March and are open for consultation, giving health professionals and organisations a chance to feed back their views before it’s finalised. 

At Blood Pressure UK we believe that patient-led care is vital for improving treatment of blood pressure, with the patient being given the right information to make a choice between taking medication or making lifestyle changes. We do not feel the guidelines go anywhere near far enough to tackle the huge numbers of people living with undetected or uncontrolled blood pressure.

Professor Graham MacGregor, Chairman of Blood Pressure UK, was quoted in The Sun, saying: “My own view is that it is up to the individual. But there are hidden millions who would benefit from treatment, but are unaware of their risk.”

We will publish our official response in April.  

You can also comment as an individual, though NICE recommends commenting through an organisation and we would be delighted to add any comments you may have to our submission. Please email Katharine Jenner at katharine.jenner@bloodpressureuk.org before 12 April. 

Read more 

See the draft guidelines from NICE. 

See the key message from NICE in their press release. 



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