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NICE pushes ambulatory blood pressure monitoring in quality standard

GPs should confirm a diagnosis of hypertension by ambulatory blood pressure monitoring and investigate for organ damage within a month of a diagnosis, according to a new quality standard from NICE.

The draft quality standard, published today, requires GPs to offer statins to patients newly diagnosed with hypertension and a 10-year cardiovascular disease risk of 20% or higher and refer patients taking four antihypertensive drugs with uncontrolled blood pressure to a specialist.

Based on NICE guidelines, it also said people with treated hypertension should have a clinic blood pressure target set to below 140/90 mmHg if aged under 80 years, or below 150/90 mmHg if aged 80 years and over; targets that are being introduced into the QOF this year.

It added that GP should discuss the risk factors for cardiovascular disease annually with patients with hypertension.

Dr Terry McCormack, a GP in Whitby, Yorshire, who was part of the topic expert group that wrote the quality standard, said that it was ‘reasonable’ and would be endorsed by the British Hypertension Society.

He said: ‘It’s not going to be a difficult standard. Most people are happy with the NICE guidelines, and the quality standard is based on them.’

He added that  ambulatory blood pressure monitoring had many benefits, and that worries over the costs of equipment were overblown.

He said: ‘Ambulatory blood pressure monitoring will be the most difficult for GPs, but we should do it as it makes us more efficient and reduces workload. We can get on, make the diagnosis faster. It actually saves consultation time because the patient doesn’t have to keep coming in.’

‘The only worry is the cost of equipment. But the cost of equipment has halved in price since guidance came out. North Yorkshire PCT is helping GPs with the cost, so I’m sure other PCTs will follow suit.’

Dr Kathryn Griffith, a GPSI in cardiology in York, said the quality standard helpfully summarised widely-accepted NICE guidance.

She said: ‘Sometimes it’s hard to see the wood for the trees with NICE guidance. So with this they’re taking 350 pages and putting it into one page. They’re very good things for patients, but they’ll take a bit of organisation from practices to implement.

She added that offering statin therapy to elderly patients might be problematic: ‘One problem is that most of our hypertensives are hypertensives because they’re elderly. You might not want to give them more statins. In a younger patient who is at high risk not because of their age we should think about treating them more aggressively with statins, but I’d have to look at the evidence for the elderly.’

Readers' comments (2)

  • Vinci Ho

    NICE guidance accepts 7 days of Home BP monitoring , HBPM with home BP machines, as an alternative to ABPM for diagnosis of hypertension .
    There is no mentioning of this in here?

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  • Good point there Vinci.Infact on a recent cardiology GP Update that i attended it was mentioned that home BPM is non inferior to ABPM.The difficulty is in deciding whether or not to initiate treatment in the white coat hypertensives who have have normal home Bp readings but raised clinic values.They are at a higher risk of stroke but there have been no trials to address whether antihypertensive treatment has any value in this group of patients.Essentially we are extrapolating outcome date from the "real" hypertensives to a different population set.In the current economic climate i wonder whether it will be an effective use of resources.We should be trying to de-medicalise our population rather than constantly expanding the numbers to the benefit of big pharma.

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