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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.’