Blood pressure has been measured and recorded in the same way for nearly a century. This is set to change. Researchers believe that the earlier way has led to the misdiagnosis of many. This could be due to a phenomenon called “white coat hypertension” or rise in the blood pressure due to nervousness on meeting the medical staff. It is seen that at least 25% of the population suffers from white coat hypertension.
Guidelines published by the National Institute for Health and Clinical Excellence (Nice) recommend that patients should be monitored for 24 hours to determine if they have high blood pressure. This process, ambulatory blood pressure monitoring (ABPM), involves wearing a cuff and a box on a belt for a day as the patient goes about their daily life, to give a series of readings under normal conditions.
Cathy Ross, senior cardiac nurse at the British Heart Foundation, said, “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… This new guidance will refine the way we test and treat people for hypertension, particularly by helping to identify people suffering from 'white-coat hypertension'.”
Chair of the guideline development group Professor Bryan Williams said any patients who have been misdiagnosed will be identified during the standard review process. He said, “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…Our priority is not to advocate going out tomorrow and reviewing whether or not all the people out there who are currently treated have been diagnosed appropriately. Our priority is to get the diagnosis right in those who present going forward and use this opportunity to re-evaluate the diagnosis in others as doctors do all the time.”
It is only patients who are “right on the border line” who might need a change to their treatment, president of the British Hypertension Society professor Mark Caulfield said.
High blood pressure affects an estimated 12 million people in the UK, one in four of the adult population and one in two of those over 60. It is one of the most important causes of heart disease, stroke and kidney disease and controlling it is one of the most effective ways of preventing premature death.
The devices cost more than £1,000 and drugs prescribed for blood pressure on the NHS cost £1bn a year. Nice estimates that introducing the devices would save £10bn annually after five years. The research is published in The Lancet.
Genetic variants influence blood pressure from early in life