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NICE proposes targets on hypertension

Doctors could face targets on use of ABPM and early investigations

Louise Prime

Tuesday, 09 October 2012

Healthcare professionals must ensure that they offer people with suspected hypertension ambulatory blood pressure monitoring to confirm the diagnosis, NICE has announced in its draft quality standard. However, it acknowledges in setting targets for this standard that ABPM might be unsuitable for or simply unwanted by some patients, for example those with certain physical or intellectual disabilities, and that for these people home blood pressure monitoring is a suitable alternative.

Suspected hypertension is defined as a clinic blood pressure of at least 140/90mmHg without a confirmed diagnosis of hypertension.

NICE says that while people are waiting for confirmation of their diagnosis, they should be offered investigations to assess any target organ damage, including: testing for proteinuria and haematuria; blood sampling to measure plasma glucose, electrolytes, creatinine, estimated glomerular filtration rate, serum total cholesterol and HDL cholesterol; fundal examination to look for hypertensive retinopathy; and a 12-lead ECG. But NICE asks stakeholders to comment on whether they believe that such investigation before diagnosis has the potential to cause delays in diagnosis, rather than benefiting patients.

NICE has also asked doctors and others to give their opinions on whether the goal that statins should be offered to people with newly diagnosed hypertension and a 20% or higher 10-year cardiovascular risk, ought to refer to statins being prescribed immediately on diagnosis, within a particular time from diagnosis, or at any point in the care process.

A further question posed by NICE in the draft is whether its requirement for an annual review of care for people with hypertension – including a review of their risk of developing cardiovascular disease – is already part of current practice, and covered sufficiently elsewhere, such as by the Quality and Outcomes Framework.

People with hypertension should be treated to achieve a target (clinic) blood pressure of no more than 140/90mmHg (150/90mmHg for people aged 80 or more), says NICE. The sixth quality statement in its draft proposes that healthcare providers should be measured on the proportion of people with hypertension uncontrolled by four hypertensive drugs whom they have referred for specialist assessment.

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