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Blood Pressure Guidelines Revised in England and Wales

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Patients suspected of having high blood pressure are to wear a monitor for 24 hours because the condition is being wrongly diagnosed in millions of people who are simply nervous about visiting the doctor.

GPs should no longer rely on readings in the surgery, but should send people home with a portable monitoring device, when high blood pressure is suspected, the National Institute of Health and Clinical Excellence (Nice) has recommended.

Fears that a quarter of those in whom the condition is diagnosed are being wrongly assessed have prompted the first change in the standard method of measuring and monitoring blood pressure in more than a century.

The 12 million people in Britain who have been told that they have the condition are likely to be reassessed in annual reviews. One in four of these patients is simply experiencing the higher pulse rate that comes with waiting-room nerves, the watchdog estimates, meaning that millions are using blood-pressure drugs unnecessarily.

Although doctors say that the drugs will not be doing any harm, the NHS is wasting millions of pounds by prescribing them. Nice estimates that savings on this bill will more than offset the cost to GPs’ surgeries of having to buy the ambulatory monitoring devices, which cost about £1,000 each.

“This is clearly a very fundamental change. Practice in this area has not been changed in more than 100 years,” said Bryan Williams, Professor of Medicine at the University of Leicester, who led the development of the new guidelines. “It will ensure that those who really need treatment get treated.”

GPs are being told to switch to ambulatory monitoring over the next year. Some have questioned whether the upheaval is justified, but Professor Williams said that the monitoring would give a far more accurate picture.

“People diagnosed with hypertension [high blood pressure] are potentially treated for the next 50 years of their lives and we want to get it right. It’s a big challenge for the health service but it’s better for patients,” he said.

At present, GPs initially measure blood pressure using an inflatable arm cuff in the surgery, calling back people whose readings are high for a series of extra measurements by the same method. Under the new system, people with high readings in the surgery will be sent home with an ambulatory monitoring device to wear under their clothes.

The device automatically takes a reading about every half an hour and the average reading can be downloaded by a nurse after 24 hours.

Nice insists that such readings are significantly more accurate and a better predictor of the risk of heart attacks and strokes, which are two of Britain’s biggest killers. Anne Milton, the Health Minister, said: “This is not only better for patients, but also a better use of NHS resources.”

Up to three million people could be told that they have received a wrong diagnosis, mainly younger people who have seen no sign of pressure-related damage to the heart and kidneys.

“These are probably people who are right on the borderline, not the people with very high blood pressure,” Professor Mark Caulfield, President of the British Hypertension Society, said. “We are not advising three million people to turn up tomorrow in the GP surgery.”

A senior cardiac nurse at the British Heart Foundation, said: “It doesn’t mean current methods aren’t working, only that they can be improved. Anyone concerned about their blood pressure or treatment should speak to their GP or practice nurse.”

The guidelines also recommend that the over-80s be given drug treatment for high blood pressure. “You’re never too old to start treatment,” Professor Williams said.

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About David Gregory

  • We should not ignore the role of diet.

    Processed foods, junk food and coffee can raise blood pressure in my experience. Wearing a monitor should help solve the issue together with modifying behavior and applicable medications.