Hypertension in adults: summary of updated NICE guidance

Boffa, Rebecca J; Constanti, Margaret; Floyd, Christopher N.; Wierzbicki, Anthony S.

doi:10.1136/bmj.l5310

Cited by 68 publications

(64 citation statements)

References 6 publications

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“…However, both trials compared SBP treatment targets of 140 mmHg with more intensive targets of 120 mmHg. In addition, both trials included people who were at high risk for or already suffering from chronic conditions and therefore the corresponding findings may not be simply generalized to the general UK population [7].…”

Section: Discussionmentioning

confidence: 99%

“…In fact, as the benefits and harms of lowering BP could not be fully determined from current evidence, the existing BP targets have not been reduced in the new guideline in Europe and the UK-in the 2018 European Society of Hypertension (ESH)/European Society of Cardiology (ESC) Guideline, the definition of HTN remained unchanged, with HTN defined as office BP >140/90 mmHg [6]. Similar to the European guideline, the National Institute of Clinical Excellence (NICE) in the UK has also chosen to maintain the previous definition of HTN [7].…”

Section: Introductionmentioning

confidence: 99%

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Association between Stage 1 Hypertension Defined by the 2017 ACC/AHA Hypertension Guideline and Cardiovascular Risk: A Large Cohort Study from the UK

2020

Preprint

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Importance The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension (HTN) guideline lowered the threshold for HTN from 140/90 mmHg to 130/80 mmHg for systolic/diastolic blood pressure (SBP/DBP), resulting in a newly defined stage 1 HTN with an SBP/DBP reading of 130-139/80-89 mmHg. Few studies have assessed the impact of the redefined HTN on cardiovascular outcomes among the UK population. Objective To examine the effects of the revised ACC/AHA stage 1 HTN blood pressure parameters on the prevalence of HTN and related cardiovascular disease (CVD) risk in a large UK population. Design Adult men and women from a national cohort study in the UK. Setting The UK Biobank Study. Participants A total of 470,625 adults (mean age 56 years) with available data on blood pressure (BP) and without a history of CVDs at baseline. Main outcome measures Incident composite CVD outcome. Methods Prospective CVD events were analysed for survival in relation to BP measures using Cox proportional hazards regression models, adjusting for potential confounders. The associations are described by hazard ratios (HRs) and 95% confidence intervals (CIs). Results By adopting the 2017 ACC/AHA HTN guideline, an additional 24.7% of the participants were classified as having ACC/AHA stage 1 HTN, which resulted in a prevalence of HTN of 75.1% at baseline. During a mean follow-up period of 8.1 years, ACC/AHA stage 1 HTN (130-139/80-89 mmHg) was associated with a significantly increased risk of CVD (HR 1.20; 95% CI 1.10-1.30) compared to the risk associated with a normal BP (<120/80 mmHg). The excess risk of CVD associated with ACC/AHA stage 1 HTN was mainly driven by myocardial infarction (HR 1.19; 95% CI 1.05-1.36) and haemorrhagic stroke (HR 1.40; 95% CI 1.08-1.81), rather than ischaemic stroke (HR 1.02; 95% CI 0.87-1.19) and CVD death (HR 1.07; 95% CI 0.90-1.26). Conclusions The adoption of the 2017 ACC/AHA guideline would lead to a dramatic increase in the prevalence of HTN in the UK Biobank cohort study. Evidence from the present national cohort study may support lowering the threshold for HTN from 140/90 mmHg to 130/80 mmHg in the UK.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between Stage 1 Hypertension Defined by the 2017 ACC/AHA Hypertension Guideline and Cardiovascular Risk: A Large Cohort Study from the UK

2020

Preprint

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“…Similarly, the National Institute of Clinical Excellence (NICE) in the UK has also chosen to maintain the BP threshold of ≥ 140/90 mm Hg for hypertension [10].…”

Section: European Society Of Hypertension (Esh)/european Society Of Cmentioning

confidence: 99%

Hypertension Subtype Defined by the 2017 ACC/AHA Blood Pressure Guidelines and Risk of Cardiovascular Disease: A Large Prospective Cohort Study

2020

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IMPORTANCE The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guidelines lowered the hypertension threshold from a systolic blood pressure/diastolic blood pressure level of ≥140/90 mm Hg to ≥130/80 mm Hg. The cardiovascular impact of isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH) under the new definition remains unclear. OBJECTIVE To examine the associations of ISH and IDH defined by the 2017 ACC/AHA guidelines with risk of cardiovascular disease (CVD) among the UK population. DESIGN, SETTING, AND PARTICIPANTS We used data from the UK Biobank study, which is a prospective population-based cohort study. Participants were categorized into 5 groups: normal BP, normal high BP, ISH, IDH and systolic and diastolic hypertension (SDH). MAIN OUTCOMES AND MEASURES The primary endpoint for this study was the composite of nonfatal myocardial infarction (MI), nonfatal ischemic stroke (IS), nonfatal haemorrhagic stroke (HS) and CVD death. We also explored the results for the above mentioned CVD outcomes separately. Baseline BP measurements were obtained twice after the participant had been at rest for at least 5 minutes in a seated position. RESULTS We included 470,625 participants who were free of CVD at baseline and had available data on BP measures. During a median follow-up of 8.1 years, 13,157 CVD events were recorded, including 6,865 nonfatal MI, 3,415 nonfatal ISs, 1,118 nonfatal HSs, and 2,971 CVD deaths. According to the hypertension threshold of ≥130/80 mm Hg by the ACC/AHA guidelines, both ISH (HR 1.35, 95% CI 1.24-1.46) and IDH (HR 1.22, 95% CI 1.11-1.36) were significantly associated with a higher overall CVD risk as compared with normal BP. ISH was associated with most CVD risk, except for IS, while the excess CVD risk associated with IDH appeared to be driven mainly by MI. We found heterogeneity by sex and age regarding the effects of IDH on overall CVD risk, with significant associations in younger adults (age < 60 years) and women and null associations in men and older adults (age ≥60 years). CONCLUSIONS AND RELEVANCE Both ISH and IDH were associated with an increased risk of CVD among the UK population according to the ACC/AHA BP guidelines. Further research is needed to identify participants with IDH who have a particularly risk for developing CVD.

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“…21,22 The updated UK NICE guidelines on hypertension whose remit was primary prevention have taken a different view. 16 NICE was unconvinced by the new method of blood pressure measurement thinking that this would be difficult to implement in routine practice due to logistic problems within the NHS and also likely to underestimate the routinely used classic clinic blood pressure measure. NICE has already established that <130/80 mmHg is an appropriate target for patients with a previous stroke but that review did not address the population with coronary heart disease who are likely to receive two anti-hypertensive therapies for nonblood pressure related CVD benefits in any case.…”

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confidence: 99%

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Wierzbicki

2020

Int J Clin Pract

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Hypertension in adults: summary of updated NICE guidance

Cited by 68 publications

References 6 publications

Association between Stage 1 Hypertension Defined by the 2017 ACC/AHA Hypertension Guideline and Cardiovascular Risk: A Large Cohort Study from the UK

Association between Stage 1 Hypertension Defined by the 2017 ACC/AHA Hypertension Guideline and Cardiovascular Risk: A Large Cohort Study from the UK

Hypertension Subtype Defined by the 2017 ACC/AHA Blood Pressure Guidelines and Risk of Cardiovascular Disease: A Large Prospective Cohort Study

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