Evaluating the impact of the 2011 NICE Hypertension Guideline on the Management of Hypertension in Primary Care and Subsequent Outcomes

The National Institute for Heath and Clinical Excellence, known as NICE, is the organisation that advises doctors on best practice.  In 2011 NICE issued guidance which told doctors that they could diagnose high blood pressure using new ways of measurement.  Specifically, a blood pressure measurement made either over 24 hours or at home using portable blood pressure monitors.  The reason for this change was to better target treatment on people most likely to benefit in terms of reducing heart attacks and strokes. This was controversial at the time because critics said it would lead to less diagnoses and treatment, which in turn would mean that it was dangerous to patients.  Since then, similar recommendations have been made in North America and Japan.

Similarly, the recommendations for drug treatment changed, both through new evidence of benefit and because the costs of drugs had changed over time as newer medications came off patent.

We propose to study data from GP surgeries and hospitals in England to see what changes in the diagnosis of high blood pressure have occurred and whether these have led to worsening of outcomes for patients, ie were the concerns over the NICE recommendations justified or not.  We will also look at changes in blood pressure measurement, in GP workload and in the prescription of blood pressure drugs. We will use information collected through GP computer systems to look at data five years either side of the changed guidelines in 2011.

This information will allow us to assess the impact of NICE guidance for the diagnosis of high blood pressure on patients and doctors and on the National Health Service (NHS) more widely. The guideline will be updated in 2019 and this work will help to inform that process.