New guidelines developed by the UK National Institute for Health and Clinical Excellence (NICE; London, United Kingdom) in conjunction with the British Hypertension Society (BHS; Leicester, United Kingdom) could revolutionize the way blood pressure is diagnosed and treated.

The new guidelines (please see Related Links below) recommend that a diagnosis of hypertension should be made using 24-hour ambulatory blood pressure monitoring (ABPM), a process that involves wearing a mobile blood pressure monitor that records numerous blood pressure measurements throughout the day and night. The recommendations are based on substantial new evidence that suggest that ABPM is a more accurate and cost effective way of diagnosing hypertension than both clinic and home monitoring, and should be offered to patients if their blood pressure in the clinic is 140/90 mmHg or higher.

The move towards the use of ABPM could help avoid the white coat effect, wherein a patient experiences a temporary increase in blood pressure while having it measured by their doctor. It is thought that up to 25% of patients experience white coat effect, which could falsely indicate that a patient has high blood pressure, even if it is within the normal range during everyday life. The guidelines stress that AMBP should be used for making new diagnoses of hypertension, and that patients already diagnosed with hypertension do not need to come forward for retesting, as they will be assessed during their annual review.

“Blood pressure is highly variable so we never use a single reading. Patients are asked to come in and see their GP on at least two further occasions. But with AMBP, blood pressure is monitored throughout the day and then an average value is taken,” said Professor of Medicine Bryan Williams, MD, of the University of Leicester (United Kingdom), chair of the NICE guideline development group. “The important recommendations in this guideline will affect the treatment of millions of people in our country and change the way blood pressure is diagnosed for the first time in more than a century.”

The new guidelines also simplify the treatment strategy for high blood pressure, focusing on the most effective treatments, and also contain specific advice on the treatment of blood pressure in young adults and the very elderly.

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