NICE to consider latest blood pressure research
NICE is to examine latest research suggesting that people who have fluctuating blood pressure readings could be at greater risk of suffering a stroke than those with consistently high readings.
Researchers from the University of Oxford, together with Swedish colleagues, examined the risk of stroke in relation to variability in blood pressure and maximum blood pressure in patients who had previously had a mini stroke, and in patients with treated hypertension.
The findings, published online today in The Lancet, show that patients who had fluctuating readings at different GP visits had the greatest risk of future stroke regardless of what their average blood pressure reading was.
A separate review also found that differences in effectiveness of several blood pressure drugs could be explained by how well they control blood pressure fluctuations, also known as episodic hypertension, with beta-blockers the least effective in controlling blood pressure variations.
Lead researcher Professor Peter Rothwell, said: “I do think that all clinical guidelines need to take more account of the problems of episodic hypertension, residual variability in blood pressure in patients on treatment, and effects of different classes of BP lowering drugs on variability.
“The current recommendations that patients with some high blood pressure readings should be reassured and not treated if other readings are lower needs to be reconsidered.”
Also, the fact that this research explains why calcium channel blockers and diuretics are more effective than other agents in preventing stroke than other drug classes, and that beta-blockers increase variability, should influence treatment recommendations, said Professor Rothwell.
Professor Peter Weissberg, medical director at the British Heart Foundation, cautioned: “Current practice is not wrong, but this might add a new measure to help doctors make decisions on who to treat for hypertension and which drug to use.”
As well as producing new guidance, NICE also reviews existing guidelines to ensure that they are up-to-date and take into account the latest evidence.
Dr Gillian Leng, deputy chief executive of NICE and an expert in vascular disease said: “NICE will take this latest research into consideration when updating the current hypertension guidance.
“Substantial clinical trial data have been published since the original guideline in 2004 and the rapid update in 2006. This data, including the analysis conducted by Rothwell, needs to be reviewed in the context of existing guidance; it consolidates and strengthens the evidence for some existing recommendations and identifies important new evidence where future guidance may be needed
NICE first issued guidance for the management of hypertension in adults in primary care in 2004. The pharmacological section of this guideline was subsequently updated in 2006.
NICE expects to issue its updated hypertension guidance in August 2011.
12 March 2010
This page was last updated: 13 April 2010