NICE lowers threshold for blood pressure drugs in new guidance

New guidelines on the management of high blood pressure in the UK will see thousands more patients eligible to start drug treatment earlier, with the aim of preventing heart attacks and strokes.

The new guidance on the treatment of hypertension lowers the cardiovascular disease (CVD) risk threshold to stage 1 high blood pressure – for anyone aged under 80 with a 10-year risk of 10% or more and a blood pressure reading of at least 140/90.

Stage 1 hypertension is diagnosed when there is no simple identifiable cause of the raised blood pressure – NICE noted that the hypertension may be related, in part, to obesity, dietary factors such as salt intake, physical inactivity or genetic inheritance.

NICE says that is a reduction from the 20% CVD risk threshold in the 2011 guideline which the new document updates, and it is estimated that more than 700,000 patients in England and Wales could now be eligible for drug treatment.

At the moment, it is thought that around half of people diagnosed with stage 1 hypertension and risk below 20% are being treated with blood pressure drugs.

The changes were proposed earlier this year and almost immediately led to pushback from the British Medical Association (BMA), which said they would dramatically increase the workload of doctors in primary and secondary care.

In a letter to NICE guideline committee chair Professor Anthony Wierzbicki, the BMA said in April it was concerned that the plan “has been made on an economic model of cost-efficiency based on the treating of populations, rather than treating patients as individuals” and that the benefit for treating stage 1 hypertension was unproven.

NICE says however that the measure is needed to meet the NHS Long Term Plan to improve the management of CVD, including prevention of strokes and heart attacks, through better detection and treatment of high blood pressure.

“In 2015, it was reported that, in England, high blood pressure affected around 13.5 million people and contributed to 75,000 deaths, making it by far the biggest preventable cause of death and disability in the UK through strokes, heart attacks and heart failure,” said NICE in an emailed statement. 

“The clinical management of hypertension accounts for 12% of visits to primary care and up to £2.1 billion of healthcare expenditure,” it added.

The guidance says that NICE’s committee was “confident” that people with 10% CVD risk “should have a discussion … about starting antihypertensive treatment, alongside lifestyle changes, and that this would be a clinically and cost effective use of NHS resources.”

Other experts have suggested however that the guidelines don’t go far enough. Blood Pressure UK said when the draft guideline was published that the plans do not “go anywhere near far enough to tackle the huge numbers of people living with undetected or uncontrolled blood pressure.”

Don't miss your daily pharmaphorum news.
SUBSCRIBE free here.