Diagnoses and treatment of blood pressure is on the verge of being revolutionized following new guidelines for the medical profession by the National Institute for Health and Clinical Excellence (NICE) and British Hypertension Society (BHS).
The new guidelines mark the first time in more than a century that the way blood pressure is monitored by health professionals has been changed.
More than 25 percent of patients may have been misdiagnosed for high blood pressure. Taking repeated BP readings over a 24-hour period rather than a one-off measurement in the clinic is the most cost-effective way of deciding which people should be prescribed drugs for hypertension, according to a study published on Wednesday, along with the new guidelines.
A key component of the new guideline is the recommendation that BP readings should be diagnosed using ambulatory BP monitoring, where patients where monitors for a 24-hour period to gauge how high their blood pressure is. The ambulatory blood pressure monitoring (ABPM) device involves wearing a cuff and a box on a belt for a day. The patient brings the device back the following day so the data can be downloaded and analyzed.
Bryan Williams, professor of medicine at the University of Leicester, and chairman of the NICE hypertension guideline committee, said that patients who have been misdiagnosed would be identified as the system becomes adopted across the National Health Service (NHS).
“Everybody on treatment is under periodic, usually annual, review and that is the opportunity to consider whether or not the original diagnosis was the right one,” he told The Guardian.
Williams added that 10 percent of the NHS could introduce the new system as early as tomorrow. “Our modeling showed that for every 100,000 people this new method would cost £2.5m ($4m) in the first year. But by year five you would see savings of £10m ($16m) a year,” he said.
The panel expects the new process will take about a year to be introduced full scale and that the cost of the machines, currently around £1,000 each ($1,640), could be cut in half.
The new guidelines also recommend that people over 80 are treated for high blood pressure. In the past there has been much debate over whether this will cause more harm than good. But Williams said these patients would benefit.
High blood pressure (HBP) — or hypertension — is a major risk factor for cardiovascular disease, the leading cause of death globally. If it is left unchecked and untreated, HBP can cause stroke, heart attack, heart failure and organ damage, including kidney failure and vision problems.
Persons diagnosed with hypertension are usually prescribed medication to treat it, and many remain on blood pressure medication for years if not the rest of their lives.
“Ambulatory monitoring allows better targeting of blood pressure treatment to those who will receive most benefit,” Richard McManus of Britain’s Birmingham University, who led a study published in The Lancet medical journal which prompted the NICE guideline change, told Reuters.
“It is cost saving in the long term as well as more effective, and so will be good for patients and doctors alike,” he told Reuters.
In the Lancet study, McManus´ team analyzed the cost-effectiveness of three approaches of blood pressure monitoring and found that ABPM was the most cost-effective method in diagnosing hypertension in men and women of all ages.
Overall, it saved money in all groups and resulted in significant improvements in quality of life for both men and women in the 50-plus age group.
Some 12 million people in the UK suffer from hypertension and nearly half go undiagnosed. It is estimated that the condition costs the NHS more than $1.5 billion annually in drugs alone. Managing high blood pressure is important for patients to lessen their risk of a stroke — the third most lethal condition after cancer and heart disease, and the leading cause of severe disability. It is estimated that 20 percent of hospital beds are occupied by stroke victims.
“The number of people with high blood pressure in the UK is staggering. It’s a major risk factor for heart disease and strokes so it’s crucial we do all we can to get people diagnosed and properly treated as soon as possible,” Cathy Ross, senior cardiac nurse at the British Heart Foundation, told The Guardian.
UK´s health minister Anne Milton told The Guardian: “Hypertension is a serious public health issue that affects up to a third of the population and needs to be better managed in primary care. Getting the diagnosis right is vital in order to make sure that all patients who need treatment get it before they go on to develop a more serious condition.”
Professor Williams said in a press release: “We have spent more than a year looking at masses of new evidence from studies in great detail before coming to our conclusions. I think the UK is leading the world in developing bold and progressive treatment strategies for high blood pressure. The importance of this cannot be overstated for two reasons, first because high blood pressure is very common and affects about a quarter of all adults and more than half of adults over the age of 60yrs, and second, because treating high blood pressure is one of the most effective ways of reducing the risks of heart disease and stroke.”
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