Tuesday, 23 August 2011

NICE: Hypertension battle must move to the home front

The National Institute for Health and Clinical Excellence (NICE) is expected to announce new guidelines tomorrow for how GPs should diagnose high blood pressure in their patients.
‘White coat hypertension’ - when your blood pressure soars during a test in a surgery - could affect as much as 25 per cent of the population, NICE concluded a while ago
Inevitably where doctors have relied on surgery readings alone, there is the risk of inaccurate readings. Patients with otherwise normal pressure could be prescribed unnecessary drugs and those with a problem might be overprescribed.
Apart from bad medicine, hypertension treatments are costing the NHS over £ 1 billion a year. It was a situation that could only worsen with our aging population. I don’t know if estimates exist for the other side of the equation – the money the drugs save by preventing strokes and heart attacks.
So NICE will now recommend – indicated by an earlier draft report, “a diagnosis of primary hypertension should be confirmed using 24-hour ambulatory blood pressure monitoring, or home blood pressure monitoring, rather than be based solely on measurements of blood pressure taken in the clinic.”
I was diagnosed with high blood pressure when I was found to have type2 diabetes. That was about 15 years ago. A doctor at a hypertension clinic at St Mary’s Hospital, Paddington (I hope it’s still there), was about to prescribe tablets when a senior colleague looked at the stratospheric readings and instantly concluded I had “white coat syndrome.”
In the years that passed it was difficult to convince GPs this was the case whenever they checked my blood pressure. The simple solution suggested by a friend was that I buy a monitor and take my own readings at home.
I don’t know why this never occurred to me. Good machines aren’t cheap and care needs to be taken that they remain accurate. But several monitors down the road, I’ve never regretted the investment. My GP accepts my readings and the only medication I take is eye drops to keep my glaucoma in check; my diabetes being diet-controlled.
The big question is though my blood pressure - and cholesterol - levels - are within recognised ‘normal’ limits would there be any benefit taking the appropriate drugs and chasing rock bottom readings?
The future may lay with preventative medicine – from super-pills to the humble aspirin – but it’s not for me.
I still see the merit in the old-fashioned ‘if it ain’t broke, don’t fix it’ approach to health management. But then if I was so smart I would take more – no, any – exercise.

1 comment:

  1. White coat syndrome? It might depend on who is in the white coat. I suppose 24 hour monitoring is the most scientific way but not if the first machine is faulty as it was in my case. So the 24 hour monitoring had to be done all over again.

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What do you think? GC