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New hypertension guidance risks overdiagnosis and overtreatment

BMJ 2019; 365 doi: (Published 12 April 2019) Cite this as: BMJ 2019;365:l1657

This article has a correction. Please see:

  1. Christoffer Bjerre Haase, research assistant1,
  2. János Valery Gyuricza, PhD student2,
  3. John Brodersen, professor1 3
  1. 1Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Denmark
  2. 2Department of Preventive Medicine, University of São Paulo, São Paulo, Brazil
  3. 3Primary Health Care Research Unit, Zealand Region, Denmark
  1. Correspondence to: J Brodersen jobr{at}

The boundaries of disease should be defined by multidisciplinary panels, including patients

The UK’s National Institute for Health and Care Excellence (NICE) has launched an updated draft guideline for the diagnosis and management of hypertension in adults.1 The main changes are to recommend drug treatment of stage 1 hypertension for people with a 10% risk of cardiovascular diseases over 10 years—down from a previous threshold of 20%—and to consider treating younger adults with a risk below 10%. NICE presents limited evidence for these recommendations, concluding that “evidence suggested some benefit of treating people with stage 1 hypertension” but “most uncertainty was in treating stage 1 hypertension, particularly for people with a lower cardiovascular risk.”1

Lowering the threshold for treating hypertension has implications beyond changes to disease definitions, including risks to our wellbeing and shifts in our conceptualisation of health and disease. The new draft NICE guidance has at least three serious problems.

Firstly, the guidance does not benefit from a recently published checklist of eight essential items that must be considered before modifying a disease definition.2 This checklist has been used to scrutinise the 2017 American College of Cardiology/American …

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