In the biggest change to NICE’s previous guidance published in 2011, the level of a person’s cardiovascular disease risk at which treatment for high blood pressure can be started has been reduced.
The draft guideline recommends that blood pressure lowering drugs should be offered to people aged under 80 with a diagnosis of stage 1 hypertension who have a 10% or greater risk of developing cardiovascular disease within the next 10 years.
It is estimated that around 450,000 men and 270,000 women would fall into this category. However, it is likely that the impact of the new recommendations will in fact be lower as some estimates suggest half of people in this category are already receiving treatment.
The draft guideline also considered new studies suggesting people with blood pressure below the level at which high blood pressure is usually diagnosed (140/90mmHg) might also benefit from medication. It also looked at what the effect would be of lowering the blood pressure target for people on treatment. However, some of these studies, which formed a key part of the evidence reviewed in other recent international hypertension guidelines, were difficult to interpret because they included people who had other conditions that would also raise their CVD risk, such as chronic kidney disease. Therefore, these studies could not be directly used to inform the recommendations in this draft guidance.
Anthony Wierzbicki, Consultant in metabolic medicine/chemical pathology and chair of the guideline committee, said: “Many people with high blood pressure don’t actually know they have it because it rarely causes any noticeable symptoms. However, it is by far the biggest preventable cause of death and disability in the UK through strokes, heart attacks and heart failure. 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.”
Professor 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 your blood pressure as well as your risk of other serious conditions.”
In 2015 high blood pressure affected more than 1 in 4 adults (31% of men; 26% of women) – around 13.5 million people – and contributed to 75,000 deaths in England. The clinical management of hypertension accounts for 12% of visits to primary care and up to £2.1 billion of healthcare expenditure.
Over the last decade progress has been made to improve the diagnosis and management of hypertension: the average blood pressure in England has fallen by about 3 mmHg systolic and the proportion of adults with untreated high blood pressure has decreased. However, the Public Health England Blood Pressure Action Plan (Tackling high blood pressure: from evidence into action, 2015) called for further measures to reduce average blood pressure by a further 5 mmHg through improved prevention, detection and management.
The draft guideline supports the direction of the NHS Long Term Plan and CVD ambitions to improve outcomes in cardiovascular disease, including preventing strokes and heart attacks, through better detection and treatment of high blood pressure.
The draft guideline is open for public consultation until 23 April 2019. Final guidance is expected to be published in August 2019.