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NICE to consider evidence supporting BP target of 120mmHg, says expert

NICE experts are due to look at evidence later this year that a lower blood pressure target of 120mmHg significantly lowers cardiovascular mortality, delegates at Pulse Live have heard.

GP Dr Terry McCormack, who advises NICE on its existing guidelines, said he and colleagues ‘will be discussing’ the option of updating targets, after US research showed that more intensive control of blood pressure below the current target of 140mmHg improved outcomes.

NICE confirmed the guidance was under review, but said it would not necessarily be updated.

Speaking at Pulse Live today, Dr McCormack, a GP in Whitby and secretary of the British Hypertension Society, told the audience that data from the SPRINT trial would be considered by the NICE committee later this year when it decides whether or not to update it.

The US research was a randomised controlled trial included more than 9,000 patients, typically aged around 70 and with at least one cardiovascular risk factor – but not diabetes – and an average baseline blood pressure of 139/78mmHg.

Results – unveiled provisionally last September and subsequently published in the New England Journal of Medicine – showed patients who received an intensive treatment regimen got their systolic blood pressure down to around 121mmHg, compared with around 136mmHg in the standard treatment group. Cardiovascular events or death were reduced 25% in the intensive treatment group compared with standard treatment.

Dr McCormack said this and other evidence, including two recently published meta-analyses that found a benefit from lowering blood pressures below the 140mmHg target, meant NICE advisors on the existing guidelines were considering an update to the recommendations for the first time since they were published in 2011.

Dr McCormack said: ‘Every year we are asked if there is new evidence to update the guidelines and every year the answer has been “no” until this year.

‘This is something we are going to discuss – whether it will drive us to do another guideline I don’t know.’

He added that the trial had some flaws and that it could just support using three, rather than two, antihypertensives in patients with blood pressures around 140mmHg.

GP experts previously told Pulse the new evidence could have ‘major implications’ for general practice.

However, some GP critics of overdiagnosis and overtreatment warning current NICE targets are already set too low. Former RCGP president Dr Iona Heath previously called for targets to be relaxed and for patients to be treated only if their blood pressure is above 160/100mmHg.

A spokesperson for NICE said: ‘We’re currently carrying out the surveillance review on the guideline to see if it needs updating.

‘Any potential changes to the guideline, should the decision be taken to update it, are speculation.’

 

Readers' comments (10)

  • Just exception report everyone then and be done with it.

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  • yes, "dietary advise" and "lifestyle counselling" are the best tolerated treatments for elevated BP in my experience. exception report everyone (if QOF is still around by the time this nonsense filters through).

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  • That study did mention more side effects such as hypo tension, but no % was given, so hard to judge benefit vs problems.
    My ENT colleagues tell me that many episodes of dizziness they see = too much BP tablets.
    Certainly a J shaped curve. Much lower and you get more IHD.
    Jury is still out.

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  • Oh dear ... diminishing returns again. I
    shall be " signposting" patients to the NNT
    website. Might preserve some primary care
    appointments in the face of the coming
    apocalypse.

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  • Pharma industry seem to have a good foothold in NICE. They choose to ignore the fact that with age and natural tendency to weight increase the blood pressure tends to rise. I'm not talking of obesity here.
    We had a guidance not so long ago to keep systolic below 126 for patients with diabetes, renal problems and even that caused problems. Hence,this target limit of 120 systolic is unacceptable.
    No better way than to medicalize the normal and squander precious and dwindling NHS resources.

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  • NICE to consider the prevalence of falls in over-treated BP patients. No? Didn't think so.

    More nonsense.

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  • And if we reduce systolic BP to 120 big pharma makes more. If patients then really live longer they develop more chronic problems, which all require more medication, and big pharma makes more again. This is assuming that 'someone' will pay for this! I don't think the NHS, if still existing, will have the money to fund it.

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  • "Cardiovascular events or death were reduced 25%"
    Please stop quoting meaningless relative risk figures. Tell us the absolute reductions.
    Who funds the British Hypertension Society and dose Dr McCormick have any conflicts of interest??

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  • The NNTs are pretty good as one would expect because these patients averaged about 70, and risk of death goes up a lot with age these days. So the 25% reduction in mortality sounds pretty good.
    The NNT of 61 to stop 1death of any cause over 3.26 years.
    Or about 200person years of treatment maybe not so good
    Life expectancy at 70 is about 15years, so take an extra BP tablet a day for 13years and live a year longer on average.
    As most are going to be on meds anyway it's taking out and swallowing an extra tablet, say 1minute, 6hours a year 100 hours over 13years, round up to a week of taking tablets but live a year longer. Sounds OK to me.
    Cost of 13years of BP meds maybe £200 if your a cheap skate and listen to the CCG pharmacists, £600 if you use indapamide MR like me.
    Not as cheap as giving a statin as we have good evidence that they save 8-10times their cost by reducing hospital cost, but still cheap.

    And I have been to a couple of BHS conferences in the past, sure there is pharm. but they are a great bunch, well worth listening to.

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  • No time to measure BP accurately in primary care and it fluctuates dramatically in any case! 3 reading over how many minutes - I can't remember and all the time you have to tick qof boxes without making the patient talk! I agree with explaining NNT to the patient. Treating BP is like immunisation. You are taking the pills for the community effect without likely benefit to the individualindividual.

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