Millions could receive drugs for high blood pressure in effort to prevent heart attacks and strokes

Move to lower threshold for prescribing pills 'likely to be controversial', say experts

Doctor checking a patient's blood pressure (Getty)

Millions of Britons could be put on blood pressure drugs in a bid to prevent early deaths from heart failure and strokes, as the National Institute for Health and Care Excellence (NICE) redraws its guidelines to prevent early deaths.

The health watchdog has been considering evidence from the US, where the advice has been changed to recommend that more are prescribed drugs such as beta blockers, to cut the risk of heart attack and strokes.

The recommendations would lower the threshold for the diagnosis of high blood pressure from 140/90 to 130/80 mmHg.

In the UK at least a quarter of adults have high blood pressure but this could increase to nearly 50 per cent if the changes are approved.

When similar guidelines were published in the US in November last year the percentage of adults with hypertension jumped from 32 per cent to nearly 46 per cent.

Experts said the move is "likely to generate controversy" despite evidence that lowering blood pressure reduces the risk of cardiovascular disease.

The Royal College of Physicians warned there were "huge commercial implications" because of the increase in the number of people treated and stated that "over-treatment should be avoided."

Professor Richard McManus, who sits on the NICE board considering the guideline, has claimed the evidence of benefits to people at low or intermediate risk of heart problems is "lacking"

“The change in definition will label individuals with a ‘condition’ that they did not previously have,” said Professor McManus, from Oxford University’s Nuffield Department of Primary Care Health Sciences, in an article for Nature Reviews Cardiology.

He also questioned whether the public would welcome the changes. “Even at current thresholds, many individuals stop taking their medication or take it intermittently,” he said.

“Therefore, expanding treatment recommendations might have little effect without paying attention to other aspects, such as promoting medication adherence and lifestyle changes to lower blood pressure.”

One study found that more than one third of patients refuse medication even when told it would reduce their risk of heart disease by five per cent over five years.

Helen Stokes-Lampard, chairwoman of the Royal College of General Practitioners, said the decision to lower the threshold for hypertension “should not be taken lightly”.

She said: “One concern GPs already have is over diagnosis — where we are prescribing medications when the benefits to the individual patient may be very limited.”

High blood pressure is one of the most important risk factors worldwide for disability and death and increases the likelihood of strokes and heart attacks.

Blood pressure pills such as ACE inhibitors and beta blockers cost as little as 10p a day while diseases caused by hypertension are estimated to cost the NHS over £2bn every year and account for 12 per cent of all visits to GPs in England.

Research by Oxford University found that every 10mmHg reduction in systolic blood pressure cut the risk of stroke and heart attack by a quarter.

NICE began considering the new guidelines for hypertension in June 2017 but is not due to publish until 22 August next year.

The updated guidelines are to cover adults over 18 with hypertension, with special consideration to people of South Asian, West African and Caribbean family origin and people above 80.

“Our advisory committee will follow the evidence and apply our normal process for making their recommendations, which takes into account costs and benefits and which will be subject to consultation in due course,” said a NICE spokesperson.