High blood pressure readings should be confirmed at home - NICE (UK)
High blood pressure readings in the doctor’s office should be confirmed by Ambulatory Blood Pressure Measurement, or by averaging readings taken using a home blood pressure monitor according to the draft guidelines issued by Britain’s influential watchdog, the National Institute for Health and Clinical Excellence, (NICE).
This recommendation, is one of a number of proposed changes to the previous guidelines issued by the organisation in 2006, which are published in a consultation document available here.
CHBP welcomes this move, though the emphasis should have been more on home monitoring than ABPM which is an expensive alternative to choose when faced with high readings in the doctor’s office. It probably would not add much to a series of home-based readings. If the NICE draft recommendations remain as they are, it will inevitably encourage people to become more involved in the management of their own blood pressure which is important to success rates.
One wonders how many people will end up having a revised diagnosis as a result of this; and how many will be able to come off their medication? Furthermore, with a dangerous condition like this, overdiagnosis is probably better than underdiagnosis, yet we are still failing to diagnose about a third of cases.
High blood pressure readings in the doctor’s office are often a result of what is known as ‘white coat hypertension’ – the readings are normal when taken anywhere outside the doctors office.
We still do not have a definitive answer to the question of what to do with 'white coat’ hypertensives. Is the condition a precursor to hypertension, and if so is there benefit from treating it, and at what cost?
Perhaps most importantly, we are not doing enough to encourage and support lifestyle changes – that would be the best way to keep the UK’s drug bill down!
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