New hypertension guidance risks overdiagnosis and overtreatment

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 …