Conventional hypertension prescribing ‘should be reconsidered’
pharmafile | March 16, 2010 | News story | | NICE, hypertension
New findings throwing doubt on conventional wisdom about high blood pressure may have implications for NICE’s advice on hypertension.
Published in The Lancet, the research suggests people with fluctuating blood pressure could in fact be at greater risk of a stroke than those with consistently high readings.
“NICE will take this latest research into consideration when updating the current hypertension guidance,” admitted Dr Gillian Leng, deputy chief executive of NICE and an expert in vascular disease.
The updated guidance is not expected until August next year. It was first issued in 2004 and revised two years later.
The new study by the University of Oxford and Swedish researchers looked at the risk of stroke in relation to variability in blood pressure, taking into account maximum blood pressure in patients who had previously had a mini-stroke, and in patients with treated hypertension.
The results show patients with fluctuating readings at different GP visits were at the greatest risk – their average blood pressure reading made no difference.
In a separate review, beta-blockers were the least effective drugs when it came to controlling blood pressure variations.
The effectiveness of drugs depended on how well they control these differences, also known as episodic hypertension, the study suggested.
Lead researcher Professor Peter Rothwell said all clinical guidelines should “take more account of the problems of episodic hypertension, residual variability in blood pressure in patients on treatment, and effects of different classes of BP-lowering drugs on variability”.
“The current recommendations, that patients with some high blood pressure readings should be reassured and not treated if other readings are lower, needs to be reconsidered,” he concluded.
But Leng said: “This data, including the analysis conducted by Rothwell, needs to be reviewed in the context of existing guidance.
“It consolidates and strengthens the evidence for some existing recommendations and identifies important new evidence where future guidance may be needed.”
The British Heart Foundation also warned that the new findings did not mean current hypertension practice was wrong.
“But this might add a new measure to help doctors make decisions on who to treat for hypertension and which drug to use,” said the charity’s medical director Professor Peter Weissberg.
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