NICE Guidelines Change in Response to Hypertension Study Results

The most cost-effective method of determining who should be prescribed drugs for hypertension is to take repeated blood pressure readings over a 24-hour period.

According to a recent study, the most cost-effective method of determining who should be prescribed drugs for hypertension is to take repeated blood pressure readings over a 24-hour period, not just one reading.

This method of taking multiple readings over a 24-hour period is known as ambulatory blood pressure monitoring; after this study was published, Britain's health costs watchdog, the National Institute for Health and Clinical Excellence (NICE) changed the guidelines on how the diagnoses and treat high blood pressure in order to include this new method of reading.

This alteration in guidelines will indefinitely affect the course of treatment of millions of people in Britain, and is "a step-change that is likely to be replicated across the world,” said Bryan Williams, a professor of medicine at the Leicester University and chair of the NICE guideline development group.

Traditionally, diagnosing hypertension has been done by taking a blood pressure reading in the clinic, but prior studies have found that taking a reading at home or through ambulatory measurements yield truer results. Many experts believe this is due to the fact that blood pressure can be artificially elevated when a patient’s reading is taken in a clinical setting due to his or her nervousness about being in a doctor’s office, or what is known as the "white coat effect.”

Patients who are diagnosed with hypertension are usually prescribed a blood pressure lowering medication that they must take faithfully for a long period of time—sometimes even until the end of their lives.

"Ambulatory monitoring allows better targeting of blood pressure treatment to those who will receive most benefit," reported lead researcher Richard McManus of Britain's Birmingham University.

"It is cost saving in the long term as well as more effective, and so will be good for patients and doctors alike," continued McManus.

Ambulatory blood pressure measurements require the patient to don a blood pressure cuff which is attached to an automatic blood pressure machine. Measurements are taken typically every 30 minutes throughout the day, and every 60 minutes over the course of the night.

The researchers in the study aimed to assess the cost-effectiveness of the three different reading approaches, and eventually discovered that ambulatory monitoring was the most cost effective and reliable method of diagnosing hypertension in both males and females of any age.

Not only did this method save money for all patients involved, but it also yielded significant improvements in quality of life for both men and women over the age of 50.

"The use of ambulatory monitoring will ensure quicker and more accurate diagnosis," McManus said, continued to state that this is "an exciting advance which I am sure will be taken up internationally."

This study was published in The Lancet.