More people in need of high blood pressure pills
Millions of people will be prescribed high blood pressure pills under guidelines to prevent early deaths.
Health watchdog Nice is drawing up recommendations for GPs aimed at cutting the number of heart attacks and strokes.
The guidelines, due early next year, are expected to lower the threshold at which GPs diagnose and treat high blood pressure.
Doctors estimate up to a third of all adults – 14million in England – would therefore be eligible for medication, including those in their 40s and 50s.
Others would be urged to avoid salty food, cut back on alcohol and caffeine, and lose weight.
The costs of these drugs are cheap and vary from about 28p to £1 a day.
But if 14million patients were to start taking them – which is highly unlikely – the NHS would spend at least £140 million a year.
Many GPs will be unwilling to prescribe the drugs, even if patients are eligible, as they are worried about side effects including dizziness, headaches, frequently needing the toilet, thirst, and cold hands and feet.
A recent NHS survey suggested 14 per cent of adults were on pills for high blood pressure, but experts believe as many as one in three adults suffer the condition. It is the third biggest cause of disease after smoking and poor diet and greatly increases the risk of heart attacks and strokes.
High blood pressure is known as a ‘silent killer’ as it does not have symptoms but puts extra strain on the blood vessels, heart, brain, kidneys and eyes.
It is treated through daily pills including ace inhibitors, ace inhibitors, Angiotensin-2 receptor blockers (ARBs), diuretics, and beta blockers.
These either widen the blood vessels or slow the heart rate to bring the blood pressure back down. Once patients start taking the drugs they are usually on them for many years – and, in some cases, for life.
Nice decided to review guidelines after a number of studies showed offering medication more widely could save lives.
An ideal blood pressure reading is between 90/60 millimetres of mercury (mmHg) and 120/80.
The top number – the ‘systolic’ reading, which should ideally be between 90 and 120 – is considered more important.
Nice currently recommends adults are prescribed high blood pressure pills if their top reading is above 150mmHg and bottom reading above 95mmHg.
But in 2015 a US trial found offering medication to patients just below this reading cut their risk of dying by 25 per cent.
They prompted the US watchdog to publish new guidelines last November, stating that doctors should offer treatment to patients with a systolic reading above 140mmHg.
If Nice were to follow suit, approximately a third of men and women in England would be eligible for drugs. These would include many more in their 40s and 50s, particularly if they were obese or had diabetes.
But despite the increased cost of prescribing more pills, experts say the NHS would save money if there were fewer heart attacks and strokes. There are about 200,000 hospital visits a year due to heart attacks and about 30 per cent are fatal.
Nice said it was ‘updating our guideline on the diagnosis and management of hypertension (high blood pressure)’.
It added that draft guidelines would be published early next year with the final version due in August 2019 after consultation.
Maureen Talbot, of the British Heart Foundation, said: ‘High blood pressure, often nicknamed the silent killer, affects nearly 30 per cent of adults.
‘As high blood pressure often goes unnoticed, it’s important for doctors to find those affected because, without treatment, patients are at increased risk of heart attack and stroke.’
Southampton GP Dr Chris Aden – an expert in cardiovascular disease – told Pulse magazine that if Nice followed the US guidelines, a third of adults would be eligible for treatment. He said: ‘It’s going to be challenging in terms of the numbers they’re suggesting.’
Professor Helen Stokes-Lampard, of the Royal College of General Practitioners, said the decision on new guidelines ‘must not be taken lightly’, adding: ‘One concern GPs already have is overdiagnosis – where we are giving a label to a situation thereby medicalising it, and prescribing medications when the benefits to the individual patient may be very limited.’