Intended for healthcare professionals

Rapid response to:

Practice Guidelines

Hypertension in adults: summary of updated NICE guidance

BMJ 2019; 367 doi: (Published 21 October 2019) Cite this as: BMJ 2019;367:l5310

Rapid Response:

Please make this article available to everybody

The article and infographics you have published are absolutely excellent. As education, planned care and self care lead for my CCG, I will share this with all clinicians in our CCG. My big ask to the BMJ is to make this article and a good quality pdf of the infographic available not only to members, but to the world and not to restrict it.

There are 2 issues that I believe still need addressing:

In light of the recent evidence of the The Hygia Chronotherapy Trial, which is published in the European Heart Journal, that taking BP tablets at night may even be more beneficial in terms of a 45% risk reduction in Cardiovascular Morbidity and Mortality, this is a publication that was too recent to be included or let's say at least mentioned in the NICE guidance. One could argue that as there is little perceptible harm we should start recommending this straight away, and I know some secondary care consultants in our local hospital have started doing this.

As Self Care lead in my CCG, I am a little disappointed that even in the newest edition of the NICE guidance ambulatory 24 hour measurement of BP is still classed as superior to DIY measurement by patients at home. Although I agree that nightly spikes are not picked up by home measurement, I also can see in everyday practice that patients who do their own home readings appear in better control of their blood pressure, are more motivated to lead a healthier lifestyle and are more adherent to treatment. In the times of Shared Decision Making we may have to start, as doctors and guidance producers, that academia doesn't outweigh patients' emotions and motivational issues. Perhaps, ambulatory 24 hr BP monitoring becomes less important when we consistently implement the new guidance of a) aiming to treat HTN below target and b) taking HTN medications at night?

Competing interests: No competing interests

06 November 2019
Martin Kittel
General Practitioner and Self Care Lead for East Berks CCG
GP at Forest Health Group, Bracknell and board member East Berks CCG