Updated NICE guidance on hypertension published
NICE has published an update to its guideline on the diagnosis and management of hypertension in adults (NG136). The new guidance replaces CG127, published in 2011.
The definition of hypertension in the new guidance is unchanged, for example Stage 1 hypertension is still defined as a clinic blood pressure (BP) of 140/90mmHg to 159/99mmHg and a subsequent average daytime ambulatory or home blood pressure monitoring (ABPM/HBPM) measurement of 135/85mmHg to 149/94mmHg. However, NICE has lowered the cardiovascular disease (CVD) risk threshold at which antihypertensive treatment should be considered. It now recommends discussing the commencement of drug treatment with adults <80 years with persistent stage 1 hypertension who have a 10-year risk of cardiovascular disease of ≥10%; in the 2011 guidance, the risk threshold for commencing drug treatment was 20%. Antihypertensive drug treatment should be offered to adults of any age with persistent stage 2 hypertension (ie a clinic BP of 160/100mmHg to <180/120mmHg and an average ABPM/HBPM of ≥150/95mmHg). Patients with stage 3 or severe hypertension (clinic BP ≥180/120mmHg) should be assessed for target organ damage and referred to a specialist on the same day, if necessary.
Some changes have also been made to the drug treatment recommendations. Monotherapy using an ACE inhibitor/angiotensin II-receptor blocker(ARB) or a calcium-channel blocker (depending on age, ethnicity and diabetes status) is still recommended at Step 1. However, thiazide-like diuretics are now recommended earlier, as an option at Step 2 when dual therapy is required; in the previous guidance, they were only recommended at Step 3 as triple therapy in combination with both an ACE inhibitor/ARB and a calcium-channel blocker. NICE notes that a thiazide-like diuretic such as indapamide should be used in preference to a conventional thiazide diuretic such as bendroflumethiazide or hydrochlorothiazide.
The full guidance is available to download from the NICE website, along with a two-page visual summary that includes diagnosis and treatment algorithms.