Shake-up for blood pressure diagnosis backed by NICE
New guidelines on identifying cases of hypertension have been hailed as the biggest shake-up in blood pressure diagnosis in more than a century.
Guidance published today by the National Institute for Health and Clinical Excellence recommends the use of 24-hour blood pressure monitoring instead of a series of tests carried out in clinics.
The devices, known as ambulatory blood pressure monitors, are worn by the patient for a day and take a series of readings automatically, which can then be downloaded onto a computer and assessed.
Although each device costs around £1,000, NICE said the innovation would pay for itself within three years by reducing misdiagnoses.
Recent research, including a study published today in the Lancet, suggests that 24-hour monitoring is more accurate than tests in clinics.
This is partly due to the “white coat effect”, in which patients’ blood pressure goes up when they are in unsettling clinical surroundings.
Under NICE’s new recommendations, patients should be given their first blood pressure reading in a clinic by a doctor or nurse, as they currently do. Where a reading is 140 over 90 or more, they should be fitted with an ambulatory monitoring device, which enables diagnosis in 24 hours. Currently, many patients have to return to the clinic for further readings to confirm the diagnosis.
Michaela Watts, a hypertension nurse specialist who sat on the guideline development group, told Nursing Times: “Fifteen to 30 per cent of the population have ‘white coat’ hypertension. This method is much more representative and much quicker.
“I have been using these for six or seven years – I’ve found involving people in their own diagnosis is empowering for patients.”
Professor Bryan Williams of the University of Leicester, who chaired the guideline development group, said: “This is the biggest change in the diagnosis of high blood pressure for more than a century.
“It is all about getting the diagnosis right, and treating those who need treatment and not those who don’t. I am under no illusions about the challenges to implement this but I believe it is a step-change that is likely to be replicated across the world.”
Where ambulatory monitoring is not suitable for a patient, NICE recommends home monitoring.
NICE has also recommended prescribing antihypertensive drugs to people over the age of 80 for the first time. Patients with stage one hypertension and another condition such as diabetes or heart disease could benefit from drug treatment, the body said.