Hypertension in adults: summary of updated NICE guidance

Blood pressure targets · Reduce clinic blood pressure to below 140/90 mmHg and maintain that level in adults under 80 with hypertension · Reduce ... Skiptomaincontent Education Hypertensioninadults... Hypertensioninadults:summaryofupdatedNICEguidance Practice Guidelines Hypertensioninadults:summaryofupdatedNICEguidance BMJ 2019; 367 doi:https://doi.org/10.1136/bmj.l5310 (Published21October2019) Citethisas:BMJ2019;367:l5310 Article Relatedcontent Metrics Responses Peerreview RebeccaJBoffa,seniorresearchfellow1,MargaretConstanti,seniorhealtheconomist1,ChristopherNFloyd,clinicaladviser23,AnthonySWierzbicki,chairofguidelinecommitteeandconsultantinmetabolicmedicine/chemicalpathology4onbehalfoftheGuidelineCommittee1NationalGuidelineCentre,London,UK2DepartmentofClinicalPharmacology,King’sCollegeLondonBritishHeartFoundationCentre,London,UK3BiomedicalResearchCentre,ClinicalResearchFacility,Guy’sandStThomas’NHSFoundationTrust,London,UK4Guy’s&StThomas’NHSFoundationTrust,London,UKCorrespondencetoRBoffarebecca.boffa{at}rcplondon.ac.ukWhatyouneedtoknowDiscusstreatmentwithpeoplewithstage1hypertensionanda10yearriskforcardiovasculardisease≥10%Choiceofantihypertensivedrugtreatmentshouldtakeintoaccountpatientpreferences;anewdecisionaidhasbeenproducedtosupportthisConsistentlymaintainbloodpressurebelowtarget,ratherthanaimforatargetExistingbloodpressuretargetshavenotbeenlowered;thebenefitsandharmsofloweringthemcouldnotbefullydeterminedfromcurrentevidenceAsymptomatic,severehypertension(≥180/120mmHg)doesnotrequiresamedayspecialistreview,butinvestigationsfortargetorgandamageshouldbecarriedoutassoonaspossibleTheguidelinenowmakesrecommendationsforpeoplewithtype2diabetesHypertensionisaleadingglobalcauseofmorbidityandmortality.Morethan25%oftheadultUKpopulationhashypertension,andinabout30%bloodpressureremainsuncontrolled.1InAugust,theNationalInstituteforHealthandCareExcellence(NICE)publisheditsupdatedguidelineonthediagnosisandmanagementofhypertension.Theguidelinereviewsfurtherevidencethathasemergedsinceitwaslastupdatedin2011fromrandomisedtrialsinvestigatingtheinitiation,monitoring,andchoiceofantihypertensivetreatment.Thescopeoftheupdatedguidelinehasincreasedtoalsoincludepeoplewithtype2diabetes,butdoesnotmakerecommendationsforpeoplewithchronickidneydisease,establishedcardiovasculardisease,orhypertensioninpregnancy.ThisarticlesummarisesthemostrecentrecommendationsfromNICEandincludesinformationconsideredtobemostrelevanttoprimarycareclinicians.Keychangestocurrentpracticeincludeofferingdrugtreatmenttopeopleatalowerthresholdfor10yearriskofcardiovasculardisease,emphasisonmaintainingbloodpressurebelowtarget,andclarifyingcriteriaforsamedayspecialistreviewinpeoplewithacceleratedhypertension.RecommendationsNICErecommendationsarebasedonsystematicreviewsofbestavailableevidenceandexplicitconsiderationof…ViewFullText Login Loginusingyourusernameandpassword BMAMemberLogIn IfyouhaveasubscriptiontoTheBMJ,login: Username* Password* Forgotyourlogindetails? 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