Experts call for mass medication to curb Britain's 'silent killer'

A Government agency calls today for the mass medication of the British population to protect against a "silent killer" that is threatening the lives of 40 per cent of adults.

A Government agency calls today for the mass medication of the British population to protect against a "silent killer" that is threatening the lives of 40 per cent of adults.

High blood pressure affects 14 million people in the UK and is a major cause of heart attacks and strokes, but almost 10 million receive no treatment despite the availability of cheap, reliable drugs, specialists say.

In the most far-reaching drug intervention ever recommended by an official body, new guidelines launched by the National Institute of Clinical Excellence (Nice) call for the extension of treatment to the millions at risk to save lives.

A spokesman said: "This is by far the biggest impact guideline we have issued because so many people have high blood pressure."

The World Health Organisation said in 2000 that high blood pressure was the single most prolific cause of preventable deaths. It damages blood vessels in the eyes, the heart and the kidneys and is a major cause of cardiovascular diseases, which account for 30 per cent of all deaths in the UK.

But despite the havoc it wreaks, most people with high blood pressure feel well and are unaware their health is at risk. One-third of the 14 million people with the condition in the UK do not know they have it, and a further third who do know are not being treated. Of the four to five million people receiving treatment, one third are not being adequately controlled by drugs, Bryan Williams, professor of medicine and director of the cardiovascular research unit at the University Hospitals NHS Trust, Leicester, said.

Professor Williams, who was involved in drawing up the guidelines, said they were among the most robust ever issued. "Hypertension is often referred to as the silent killer because it does not present symptoms until it has already taken hold and caused damage," he said. "We hope the impact of these guidelines will mean fewer people will have strokes and heart attacks. If the population is to live longer, giving treatment to prevent disease is the best option even though it takes a long time to realise the benefits. I think this is the way to go and it is long overdue.

"There is more data on the treatment of hypertension than on any other treatment in medicine. We can answer the question of what works with a high degree of certainty."

Although no estimate has been made of the cost of extra drug treatment, he said it was "highly likely to be cost effective" because of the saving in treatment for heart attacks and strokes. He denied that Nice was promoting the use of drugs that could cause side effects for a symptomless condition. Even treatment with a single drug could cut heart disease by 20 per cent and the drugs had few side effects, he said.

Wendy Ross, a GP in Newcastle who helped devise the guidelines, said: "Once people start treatment they are likely to be taking tablets for the rest of their lives. Most are quite keen to avoid that and want to find out what they can do [about changing their lifestyle]."

The guidelines would lead to more people taking more drugs, she said. "There are still a lot of people out there taking one or two drugs who are not very well controlled. They need three or four drugs," she said. The NHS spent £840m on drugs for high blood pressure in 2001, accounting for 15 per cent of the cost of all drugs prescribed by GPs. Andrew Dillon, chief executive of Nice, said spending was set to rise sharply as a result of the guidelines but the amount had yet to be calculated.

Nice also publishes guidelines for the treatment of dyspepsia (indigestion) today, with a recommendation that most patients can be helped to care for the problem themselves with over-the-counter drugs.

* One in six hospitals does not have a stroke unit, which is "unacceptable", the Royal College of Physicians said yesterday. A national audit of stroke treatment found that although the care of patients was improving, it still fell short of the care given to heart patients.

THE GUIDELINES

* People with at least three blood pressure readings above 140/90 mmHg, taken on separate occasions, should be offered advice on how to reduce it by changing their lifestyle, and assessed for their risk of heart disease.

* This may involve changes to the diet, reducing weight and increasing exercise. Cutting back on alcohol, salt and caffeine and practising relaxation may also help to lower blood pressure. Stopping smoking does not reduce blood pressure but is important to cut the risk of heart attacks and strokes.

* If lifestyle changes do not work, drug treatment should be offered to those with a significantly increased risk of heart disease, based on blood and urine tests and family history.

* People with persistently high blood pressure of 160/100 mmHg or more should automatically be offered drug treatment.

* Drug treatment should begin with a diuretic, which increases urine production, and further drugs such as beta-blockers, calcium channnel blockers and ACE inhibitors should be added as necessary until the target blood pressure is reached.

* The drugs are off patent, available in cheap, generic form and are safe with few side effects.