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NICE blood pressure guidance could 'bankrupt NHS'

NICE will approve a controversial recommendation for GPs to diagnose all new patients with hypertension using ambulatory blood pressure monitoring despite a warning that a resulting increase in referrals could 'bankrupt the NHS'.

A version of the final guidance, published on the NICE website, retains the recommendation that GPs should offer ambulatory blood pressure monitoring for any patient with a clinic blood pressure of 140/90 mmHg or higher, as first announced in draft guidance published in February. The final version will be published in August.

But primary care experts have called the recommendation, which will heap a bill of around £1,500 on practices who decide to purchase validated ambulatory blood pressure monitoring devices, 'excessive'. GP members of the guideline development group have told Pulse that NICE is aware practices will be reluctant to make the capital outlay to purchase the devices.

Secondary care organisations have also spoken out against the introduction of ambulatory blood pressure monitoring. An investigation by Pulse in February found four in five hospital cardiology departments do not have adequate capacity to offer ABPM to all newly diagnosed patients referred from primary care.

Dr Kathryn Griffith, a GPSI in cardiology in York and president of the Primary Care Cardiovascular Society, said: 'NICE has to recommend what has the best evidence base and that is ambulatory monitoring - but that will be an aspiration and we don't have to and can't adopt it right away.'

'The plan is for it to be done as a primary care diagnosis - we won't be referring to secondary care or anywhere else because we can't afford to. Hypertension is so common that if we referred at a cost of £70-80 per patient it would bankrupt the NHS.'

The update to the 2006 guidance features several other updates on the management of hypertension (see box).

The guideline development group also considered UK research published last year in The Lancet, which showed patients with only occasional high blood pressure readings – who are not currently diagnosed as hypertensive – are at increased risk of stroke and should be considered for treatment.

The expert group agreed that 'systolic blood pressure variability appears to be an important independent predictor of clinical outcomes', but stopped short of making recommendations on treatment. However variability is expected to feature in guidance from the Joint British Societies on the management of blood pressure, due out this summer.

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