NICE reconsiders hypertension guidance

18 March 2010

New research suggesting that people with fluctuating blood pressure readings could be at greater risk of suffering a stroke than those with consistently high readings is to be accessed by NICE with a view to possibly revising it own hypertension guidance.

Researchers from the University of Oxford 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 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."

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."

NICE last updated its Guidance for the management of hypertension in adults in primary care in 2006 and expects to issue a revised version in August 2011.

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."