Surveillance decision

Surveillance decision

We will plan a full update of the guideline.

An extension to the scope will be needed to incorporate the secondary care management of malignant hypertension, and update the recommendations on blood pressure management for adults with type 2 diabetes from NG28 Type 2 diabetes in adults.

Reason for the decision

We found 301 new studies through surveillance of this guideline.

New evidence that could affect recommendations was identified.

Topic experts, including those who helped to develop the guideline, advised us about whether the following sections of the guideline should be updated and any new sections added:

Lifestyle interventions

The CG127 update (2011) did not update the 2004 recommendations on lifestyle interventions. This surveillance review has identified a large amount of new evidence that supports the current recommendations or suggests more specific recommendations about interventions could be considered.

Decision: This area should be updated.

Initiating and monitoring antihypertensive drug treatment, including blood pressure targets

The surveillance review identified a large body of evidence that suggested self-management techniques may be beneficial, which could impact on the current recommendations.

The topic experts concurred and considered that clearer guidance for home monitoring for management of hypertension is required, and that new data on self-management may facilitate this.

Decision: This area should be updated.

Choosing hypertension treatment

New evidence identified suggests that the hypertension drug pathway could be updated. A large proportion of the new evidence identified supports current recommendations. However, there was evidence that could impact on current recommendations in the areas of general antihypertensive drugs (angiotensin receptor blockers [ARBs], angiotensin converting enzyme [ACE] inhibitors, aliskiren, thiazide diuretics, and calcium channel blockers [CCBs]) and alpha blockers.

The topic experts agreed and in particluar noted the impact on fourth-line treatments and therefore this area should be included in an update of this question.

Decision: This area should be updated. We will amend the guideline before the update of the guideline to include a footnote on the safety of ACE inhibitors/ARBs in pregnant women. The footnote will make reference to the Medicines and Healthcare products Regulatory Agency (MHRA) drug safety updates.

Patient education and adherence to treatment

New evidence identified suggests that the current recommendations on patient education and adherence could be updated. In the CG127 update (2011) the committee concluded that evidence on patient adherence was inconclusive. This surveillance review has identified a large amount of new evidence available that could allow more conclusive and specific recommendations to be made.

The topic experts agreed and noted the role of pharmacists or other health care professionals in the management of hypertension and therefore this area should be included in an update of this guideline.

Decision: This area should not be updated; instead this area should have the following amendments: recommendations 1.7.1, 1.7.2 and 1.7.4 should be removed and replaced with a cross referral to NICE guideline CG76 Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence and NICE guideline NG5 Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. Recommendation 1.7.3 should be kept.

Optimal timing of antihypertensive medication

New review question – When is the optimal time for antihypertensive medication to be taken, are evening versus morning doses associated with any significant impact on blood pressure reduction, cardiovascular outcomes or adverse events?

The surveillance review identified 5 randomised controlled trials (RCTs) and 1 systematic review comparing evening and morning doses of anti-hypertensive medication, the studies showed taking at least 1 evening dose can improve outcomes for patients with hypertension.

The topic experts agreed and noted this is an active area of research and therefore this area should be included in an update.

Decision: This question should be added to an update of the guideline.

The secondary care management of malignant hypertension

A quality standard was referred to NICE on the secondary care management of malignant hypertension, therefore an extension to scope for this guideline is required to cover this area.

Decision: The area should be added to an update of the guideline.

Blood pressure management for adults with type 2 diabetes

During the consultation for NG28 Type 2 diabetes in adults it was highlighted that the recommendations of blood pressure management required updating. Therefore this section should be removed from the type 2 diabetes guideline (NG28) and updated in the hypertension guideline.

Decision: The area should be added to an update of the guideline.

Other clinical areas

We also found new evidence that was not thought to have an effect on current recommendations. This evidence related to measuring blood pressure, diagnosing hypertension and assessing cardiovascular risk, target organ damage and secondary causes of hypertension.

Equalities

No equalities issues were identified during the surveillance process.

Overall decision

After considering all the new evidence and views of topic experts, we decided that a full update with modified scope is necessary for this guideline.

See how we made the decision for further information.


This page was last updated: 27 October 2016