NICE has today (20 March) published a new quality standard for the management of hypertension (high blood pressure) in adults, advocating that a person-centred approach is fundamental in delivering high-quality care to adults with the condition.

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. They are derived either from NICE guidance or NICE accredited sources, and apply throughout the NHS in England.

The new quality standard on hypertension consists of a prioritised set of specific, concise and measurable statements that, when delivered collectively, should contribute to improving the effectiveness, quality, safety and experience of care for people with the condition.

The quality standard contains six statements. These include:

• People with suspected hypertension are offered ambulatory blood pressure monitoring (ABPM)ⁱto confirm a diagnosis of hypertension.
• People with newly diagnosed hypertension receive investigations for target organ damage within 1 month of diagnosis.
• People with newly diagnosed hypertension and a 10-year cardiovascular disease risk of 20% or higher are offered statin therapy.

Hypertension is a major, but preventable, cause of premature ill health and death in the UK. It is a risk factor for stroke, heart attack, heart failure, chronic kidney disease and cognitive decline. Raised blood pressure is one of the three main modifiable risk factors for cardiovascular disease, (along with high cholesterol and smoking) which account for 80% of all cases of premature coronary heart disease (CHD).

There are currently about 12 million people in the UK who have hypertension, (blood pressure ≥140/90mmHg) and more than half of those are over the age of 60 years. In addition, it is estimated that around 5.7 million people have hypertension which is undiagnosed. As a consequence of commonplace, routine periodic screening for high blood pressure in the UK as part of the National Service Framework for cardiovascular disease prevention, the diagnosis, treatment and follow-up of patients with hypertension is one of the most common interventions in primary care, accounting for approximately 12% of primary care consultation episodes and approximately £1 billion in drug costs in 2006.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: "The NICE clinical guideline on hypertension published in 2011 made a number of important recommendations that are changing the way blood pressure is diagnosed for the first time in more than a century, affecting the treatment of millions of people. This new quality standard provides measurable markers that will drive further improvements in the management of hypertension, ensuring that it is diagnosed accurately, that treatments are provided and their adherence and efficacy monitored appropriately, and referral to specialists made when necessary."

Bryan Williams, Professor of Medicine, University College London and Chair of the Topic Expert Group which developed the quality standard said: "This NICE quality standard for hypertension sets out a clear framework for the management of millions of people in England with the condition. It will help to improve detection and treatment and reduce the impact of one of the most important preventable causes of premature heart disease, stroke, dementia and death."

Gareth Beevers, Professor of Medicine at Birmingham City Hospital, on behalf of Blood Pressure UK, which endorses the quality standard, said: "We are pleased to see the NICE quality standard for hypertension recommending that 24 hour ambulatory blood pressure monitoring (ABPM), or failing that, home blood pressure measurement, should be routine in the evaluation of recently diagnosed hypertensives. This is also the ideal time to encourage lifestyle corrections such as; avoiding or reducing obesity, reducing salt intake, gradually increase exercise and limiting alcohol consumption."

Trudie Lobban MBE, Founder and CEO of Atrial Fibrillation (AF) Association, which endorses the quality standard, said: "AF Association welcomes the publication of the new quality standard on hypertension. AF, a leading cause of stroke, is frequently linked with hypertension and standards which target improving patient outcomes through early detection and on-going management are welcome."

For more information please call the NICE press office on 0845 003 7782 or out of hours on 07775 583 813, or email pressoffice@nice.org.uk

Ends

Notes to Editors

References

i. ABPM is the recording of a patient's blood pressure at regular intervals under normal living and working conditions, usually across a 24 hour period.

ABPM is the most accurate method for confirming a diagnosis of hypertension, and its use should reduce unnecessary treatment in people who do not have true hypertension. ABPM has also been shown to be superior to other methods of multiple blood pressure measurement for predicting blood pressure-related clinical events.

About the draft quality standard

1. The new quality standard is available on the NICE website from Wednesday 20 March.

Related NICE guidelines and quality standards

Published

2. Hypertension: clinical management of primary hypertension in adults. NICE clinical guideline 127 (2011).

3. Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. NICE clinical guideline 67 (2008).

4. Quality standard for patient experience in adult NHS services. NICE quality standard 15 (2012).

In development

5. Hypertension in pregnancy. NICE quality standard. Publication expected July 2013.

Future quality standards

6. Lipid modification

7. Medicines optimisation (covering medicines adherence and safe prescribing)

8. Risk assessment of modifiable cardiovascular risk factors

9. Secondary care management of malignant hypertension

About NICE quality standards

1. NICE quality standards aim to help commissioners, health, social care and public health professionals and service providers improve the quality of care that they deliver.

2. NICE quality standards help demonstrate delivery of high quality care in a particular high-priority improvement area through measurable statements. There is an average of 6-8 statements in each quality standard.

3. Quality standards are derived from evidence-based guidance, such as NICE guidance or NICE accredited sources, and are produced collaboratively with the NHS, social care or public health organisations, along with their partner organisations, patients, carers and service users.

4. NICE quality standards are not mandatory but they can be used for a wide range of purposes both locally and nationally. For example, patients and service users can use quality standards to help understand what high-quality care should include. Health, social care and public health professionals can use quality standards to help deliver excellent care and treatment.

5. NICE quality standards are not requirements or targets, but the healthcare system is obliged to have regard to them in planning and delivering services, as part of a general duty to secure continuous improvement in quality.

6. Quality standard topics are formally referred to NICE by the NHS Commissioning Board, (an executive non-departmental public body, established in October 2012) for health-related areas, and by the Department of Health and Department for Education for non-health areas such as social care. Further information on the NHS Commissioning Board can be found on the NHS Commissioning Board website.

7. More information on NICE quality standards.

About NICE

1. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

2. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS
• social care- the Health and Social Care Act (2012) sets out a new responsibility for NICE to develop guidance and quality standards for social care. To reflect this new role, from 1 April 2013 NICE will be called the National Institute for Health and Care Excellence (NICE) and it will become a Non-Departmental Public Body.

3. NICE produces standards for patient care:

• quality standards- these describe high-priority areas for quality improvement in a defined care or service area
• Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
• CCG Outcomes Indicator Set (formerly known as COF) - NICE develops the potential clinical health improvement indicators to ensure quality of care for patients and communities served by the clinical commissioning groups (CCGs).

4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.