Clinical update

Hypertension: the latest NICE guidance

A guide to the main points in the National Institute for Health and Care Excellence hypertension guidance update

A guide to the main points in the National Institute for Health and Care Excellence hypertension guidance update

Stock image showing heart graphic and screen with high blood pressure reading
Picture: iStock

Essential facts

High blood pressure, or hypertension, is one of the most important treatable causes of premature morbidity and mortality in the world, according to the National Institute for Health and Care Excellence (NICE). It is a major risk factor for stroke, myocardial infarction, heart failure, chronic kidney disease, cognitive decline and premature death. In 2015, it was reported that hypertension affected more than one in four adults in England and contributed to 75,000 deaths.

What’s new?

New NICE guidance states treatment for hypertension should now be considered at a lower cardiovascular disease (CVD) risk threshold.

NICE recommends that blood pressure lowering drugs should be offered to people under 80 with stage 1 hypertension who have an estimated ten-year risk of CVD of 10% or more. This is a reduction from the 20% CVD risk threshold for treatment recommended in NICE’s 2011 guideline.

Signs and symptoms

Confirm diagnosis of hypertension in people with a clinic blood pressure of 140/90mmHg or higher and ambulatory blood pressure monitoring daytime average of 135/85mmHg or higher, according to NICE. While hypertension does not often cause symptoms, it can cause blurred vision, nosebleeds, shortness of breath, chest pain, dizziness and headaches.

Causes and risk factors

Most people develop hypertension because of their diet, lifestyle or medical condition, according to the British Heart Foundation. Drinking too much alcohol, smoking, being overweight, doing too little exercise and eating too much salt increase the risk of hypertension. People living in deprived areas are at higher risk and it is more common in people of black African-Caribbean descent.

How you can help your patient

The NICE hypertension guidance suggests:

  • While waiting for confirmation of a diagnosis of hypertension, carry out a formal assessment of cardiovascular risk using a risk assessment tool. NICE guidance on CVD recommends using the QRISK2 tool in people up to and including the age of 84. Adults aged 85 years and over and those with existing CVD, type 1 diabetes, chronic kidney disease or familial hypercholesterolaemia should be considered to be at an increased risk without using QRISK2. 
  • Offer lifestyle advice to people with suspected or diagnosed hypertension, and continue to offer it periodically. Advise that a healthy diet and regular exercise can reduce blood pressure. Ask about alcohol consumption and encourage reduced intake if high, and discourage excessive consumption of caffeine and dietary sodium.
  • In people with symptoms of postural hypertension (falls or postural dizziness), measure blood pressure with the person either supine or seated and again after they have stood for at least a minute.
  • Offer advice to smokers to stop smoking.
  • Inform people about local initiatives by healthcare teams or patient organisations that provide support and promote healthy lifestyle change, especially those that include group work. 

Expert comment

Photo of Joanna Loades, a nurse consultant and cardiovascular disease specialistJoanne Loades, independent nurse consultant and specialist in cardiovascular disease, says: ‘In a general practice about 15% of the registered patients will have hypertension, so it accounts for a huge amount of general practice nurses’ work. The change to the cardiovascular disease (CVD) risk threshold is an important one, and brings it in line with NICE guidance on CVD.

'The guidance also states the importance of not confirming a hypertension diagnosis until a patient has had out of office measurements, either from an ambulatory monitor or at home monitor. Nurses must explain to patients how to take these measurements, as it is easy to get them wrong and accurate measurements are needed for the right diagnosis.

'For all nurses who are not prescribers it is important that they know the thresholds for diagnosis and treatment. It can be easy to think it is the GP’s job, but the nurses are the gatekeepers of the care that the patients will receive, and they will be the ones referring them to the GP.’


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