The Updated NICE Guidelines Don't Go Far Enough

UK health experts aim to make blood pressure medicines more available, but is it enough?  


The National Institute for Health and Care Excellence (NICE) have updated their guidelines for health professionals who diagnose and treat high blood pressure. 

What are the NICE guidelines? 

This guideline, titled Hypertension in adults: diagnosis and management, covers identifying and treating primary hypertension (high blood pressure) in people aged 18 and over, including people with type 2 diabetes. It aims to reduce the risk of cardiovascular problems such as heart attacks and strokes by helping healthcare professionals to diagnose hypertension accurately and treat it effectively.

The guidelines are for:

  • Healthcare professionals
  • Healthcare commissioners, and providers
  • People who have or may have high blood pressure, their families and carers

NICE guidelines are updated from time to time. These guidelines are an update to the most recent version which was produced in 2011. 

What's changed? 

The most significant change in the final guidance is recommending that blood pressure medicines are offered to people with stage 1 hypertension (blood pressure over 140/90mmHg) who have a 10% risk of developing a related disease in the next 10 years, rather than a 20% risk, as in the previous guidelines. 

The idea is to prevent unnecessary heart attacks and strokes by offering blood pressure treatment at an earlier stage.  

Although this sounds like a big change, we believe it will not dramatically affect blood pressure treatment. 

Blood Pressure UK says "We don’t feel the guidelines go anywhere near far enough to tackle the huge numbers of people living with undetected or uncontrolled blood pressure.  We are disappointed that patients are still being given little say in their treatment. We also feel that there should be more emphasis on home blood pressure monitoring, based on the most recent evidence."

But there is good news - Our campaigning meant potassium salts were added back in   

The 2019 draft guidelines removed the recommendation from the previous guidelines saying that salt made from potassium instead of sodium could be used to lower salt intakes - and therefore help to lower blood pressure. 

Potassium salt tastes like regular salt, but because it doesn’t contain sodium, it doesn’t raise your blood pressure. This makes it a simple and helpful way to eat less salt.   

There wasn’t a clear reason for NICE to exclude potassium salts and the decision seemed to be based on worries about health risks. But a recent report from SACN and COT found that potassium salts are a safe and effective replacement for regular salt. So, we fed back that it was essential that NICE add them back in. And they did! 

NICE have maintained a caveat that older people and pregnant women shouldn’t use them, but we aren’t aware of the reason for this. 

Read the NICE guidelines: Hypertension in adults: diagnosis and management