Thousands more people are likely to be offered blood pressure-lowering drugs as part of a drive to prevent heart attacks and strokes. The new guidance is out for consultation until the end of April, with final guidance expected in August 2019
This edited article first appeared in The Guardian.
Draft guidelines published by the National Institute for Health and Care Excellence (Nice) recommend reducing the threshold at which treatment for high blood pressure (hypertension) should be offered. Health officials say as many as 450,000 more men and 270,000 more women may now be eligible.
However, in practice, many of these patients could already be receiving treatment because of variations in how earlier recommendations were implemented, Nice said. Some estimates suggest around 50% of this group could currently be using the drugs.
Guidance from 2011 recommends that blood pressure-lowering drugs are offered to adults under the age of 80 with stage one hypertension and a 20% risk, or more, of cardiovascular disease (CVD) over the next 10 years.
The proposed new recommendations suggest those with an estimated 10-year risk of 10% or more are offered the drugs. A stage one diagnosis means there is no identifiable cause of raised blood pressure in the patient; it may be linked to factors including obesity, salt intake, physical activity or genetics.
Anthony Wierzbicki, chairman of the guideline committee, said: “A rigorous evaluation of new evidence has resulted in updated recommendations around when to treat raised blood pressure that have the potential to make a real difference to the lives of many thousands of people with the condition.
“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.”
Prof Jamie Waterall, national lead for cardiovascular disease prevention at Public Health England, said: “High blood pressure is the country’s leading cause of heart attacks and strokes, yet millions remain undiagnosed.
“Diagnosing high blood pressure earlier, and managing it in line with NICE guidance, will save thousands of lives and years spent in ill-health. That’s why we’ve set new, national ambitions to improve the detection and management of high blood pressure within the next decade.
“If you’re over 40, getting your free NHS health check is a simple way to find out about your blood pressure, as well as your risk of other serious conditions.”
Prof Helen Stokes-Lampard, chair of the Royal College of GPs, said: “Taking steps to prevent cardiovascular disease in patients is vital to help safeguard their long-term health and wellbeing – and it is a key pledge in the NHS Long Term Plan. But many GPs do also have concerns about over-diagnosis and the unintended harms of prescribing medication to groups of patients when the benefits may be limited.
“Lowering the threshold for making a diagnosis of hypertension, or high blood pressure – a condition that already affects a very large number of patients in the UK – is likely to affect thousands, if not millions, of patients, so this decision must not be taken lightly and must be evidence-based.”
Dr Sonya Babu-Narayan, associate medical director at the British Heart Foundation, said: “We have a long way to go in improving the diagnosis of high blood pressure across the UK. Our estimates show that as many as 5 million people are living with undiagnosed high blood pressure, putting them at unnecessary high risk of a deadly heart attack or stroke.
“A focus on prevention is, rightly, at the heart of the NHS’s Long Term Plan; by diagnosing and treating more people with high blood pressure we could prevent thousands of heart attacks and strokes across the UK each year.”
A consultation on the draft guidance will close on 23 April.