Practice Guidelines

Management of hypertension: summary of NICE guidance

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d4891 (Published 25 August 2011) Cite this as: BMJ 2011;343:d4891
  1. Taryn Krause, senior project manager, research fellow1,
  2. Kate Lovibond, senior health economist1,
  3. Mark Caulfield, professor of clinical pharmacology2,
  4. Terry McCormack, general practitioner3,
  5. Bryan Williams, professor of medicine45
  6. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre Acute and Chronic Conditions, Royal College of Physicians, London NW1 4LE, UK
  2. 2William Harvey Research Institute, Barts and the London School of Medicine, and NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London EC1M 6BQ
  3. 3Whitby Group Practice, Spring Vale Medical Centre, Whitby YO21 1SD, UK
  4. 4Department of Cardiovascular Sciences, University of Leicester, Leicester LE3 9QP, UK
  5. 5Leicester NIHR Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester LE3 9QP
  1. Correspondence to: B Williams, Department of Cardiovascular Sciences, University of Leicester and Leicester NIHR Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester LE2 7LX bw17{at}le.ac.uk

Hypertension is one of the most important preventable causes of death worldwide and one of the commonest conditions treated in primary care in the United Kingdom, where it affects more than a quarter of all adults and over half of those over the age of 65 years.1 This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of hypertension,2 which updates the 2004 and 2006 clinical guidelines.3 4 5

Recommendations

NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Diagnosing hypertension

  • If blood pressure measured in the clinic is 140/90 mm Hg or higher:

    • -Take a second measurement during the consultation

    • -If the second measurement is substantially different from the first, take a third measurement

    • -Record the lower of the last two measurements as the clinic blood pressure.

(Updated recommendation) [Based on the experience and opinion of the Guideline Development Group (GDG)]

  • If the clinic blood pressure is 140/90 mm Hg or higher, use ambulatory blood pressure monitoring to confirm the diagnosis of hypertension. This strategy will improve the accuracy of the diagnosis compared with current practice6 and was also shown to be cost effective—indeed, cost saving—for the NHS. (Updated recommendation) [Based on a systematic review of randomised controlled trials ranging in quality from poor to good and on cost effectiveness evidence]

  • When using ambulatory blood pressure monitoring to confirm a diagnosis of hypertension, ensure that at least two measurements an hour are taken during the person’s usual waking hours (for example, between 0800 …

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