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Ambulatory monitoring needed for suspected high blood pressure

Person centred approach key, declares new NICE hypertension quality standard

Caroline White

Wednesday, 20 March 2013

Doctors should offer any patient with suspected high blood pressure 24 hour ambulatory blood pressure monitoring to confirm diagnosis, says a new quality standard for the management of the condition, published today by the National Institute for Health and Clinical Excellence (NICE).

And they should adopt a person centred approach to the treatment of high blood pressure. This is fundamental to delivering high quality care to adults with the condition, it says.

The new quality standard, which is intended for the optimal management of the condition in adults, covers diagnosis and investigations, treatment to reduce risk of cardiovascular disease, monitoring of treatment efficacy, and specialist referral.

It comprises six measurable statements that, when delivered collectively, should help improve the effectiveness, quality, safety and experience of care for people with the condition, says NICE.

These include:

  • People with suspected high blood pressure are offered 24 hour ambulatory blood pressure monitoring (ABPM) to confirm diagnosis.
  • People with newly diagnosed high blood pressure receive investigations for target organ damage within 1 month of diagnosis.
  • People with newly diagnosed high blood pressure and a 10-year cardiovascular disease risk of 20% or higher are offered treatment with statins.

Around 12 million people in the UK have a blood pressure that is 140/90 mmHg or higher, more than half of whom are over the age of 60. And an estimated 5.7 million people have undiagnosed high blood pressure. The condition accounted for around 12% of primary care consultations and approximately £1 billion in drug costs in 2006.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said that the NICE clinical guideline on high blood pressure published in 2011 made several important recommendations that have changed the way blood pressure is diagnosed for the first time in more than a century.

“This new quality standard provides measurable markers that will drive further improvements in the management of hypertension, ensuring that it is diagnosed accurately, that treatments are provided and their adherence and efficacy monitored appropriately, and referral to specialists made when necessary.”

Bryan Williams, Professor of Medicine, University College London and Chair of the Topic Expert Group which developed the quality standard said: “This NICE quality standard for hypertension sets out a clear framework for the management of millions of people in England with the condition. It will help to improve detection and treatment and reduce the impact of one of the most important preventable causes of premature heart disease, stroke, dementia and death.”

Speaking on behalf of Blood Pressure UK, which endorses the new quality standard, Gareth Beevers, Professor of Medicine at Birmingham City Hospital, said that a new diagnosis of high blood pressure was “the ideal time to encourage lifestyle corrections such as avoiding or reducing obesity, reducing salt intake, gradually increase exercise and limiting alcohol consumption."

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