More than 700,000 more adults could be put on blood pressure pills under new guidelines

Hundreds of thousands more people should be offered drugs that lower blood pressure, according to new guidelines for doctors from the NHS medicines watchdog intended to tackle heart attack and stroke deaths.

As many as 720,000 extra adults could be prescribed drugs such as valsartan and beta blockers under the revised prescribing guidelines proposed by the National Institute for Health and Care Excellence (Nice).

Under existing recommendations, GPs are advised to recommend medication to patients with slightly raised blood pressure and a more than 20 per cent chance of developing cardiovascular disease in the next 10 years.

This threshold has now been lowered to anyone with a 10 per cent chance in the latest draft guidelines – the biggest change since 2011.

Nice says that as many as half of these patients may already be on blood pressure drugs, but GP leaders warned there was a significant risk of over diagnosis and unintended harms from medication side effects from the changes.

Roughly a quarter of adults in the UK have high blood pressure and experts said it was by far the biggest preventable cause of heart attacks and strokes.

“Many people with high blood pressure don’t actually know they have it because it rarely causes any noticeable symptoms,” said Dr Anthony Wierzbicki, chair of the Nice panel and a heart disease specialist at Guy’s and St Thomas’ hospital.

“However, it is by far the biggest preventable cause of death and disability in the UK through strokes, heart attacks and heart failure.”

While promoting lifestyle changes – such as cutting down on salt, losing weight and keeping active – Dr Wierzbicki said the new guidelines were a shift to earlier intervention to slow age-related blood pressure increases.

But the Royal College of General Practitioners (RCGP) said a decision to confirm the draft guidelines should not be taken lightly.

“Many GPs do also have concerns about over diagnosis and the unintended harms of prescribing medication to groups of patients when the benefits may be limited,” said Professor Helen Stokes-Lampard, chair of the RCGP.

“Lowering the threshold for making a diagnosis of hypertension, or high blood pressure – a condition that already affects a very large number of patients in the UK – is likely to affect thousands, if not millions of patients so this decision must not be taken lightly and must be evidence-based.”

Blood pressure drugs including ACE inhibitors and beta blockers cost the NHS as little as 10p a day to prescribe.

However, cardiovascular disease related to high blood pressure hypertension is estimated to cost £2bn a year, and take up more than one in 10 GP appointments.

Higher blood pressure is a sign the heart is having to work harder to pump blood around the body as a result of arteries becoming narrows and stiff. This pressure can increase the chance of plaque breaking off from blood vessels and causing a clot.

The current guidelines apply to stage one raised blood pressure, the lowest category, which is not linked to a single specific cause but can be a result of obesity, too much salt, or genetic factors.

Around 450,000 men and 270,000 women would be eligible for blood pressure drugs under the new guidelines.

However, other experts said that the guidelines should have gone further, as has been the case in the US and Europe.

“The new draft guidance from Nice is surprisingly conservative,” said Professor Stephen MacMahon from the University of Oxford, warning that the target blood pressure was only slightly below the level for starting treatment.

“This will almost certainly result in large numbers of patients not achieving the full potential benefits of treatment as a consequence of inadequate reduction in blood pressure,” he said.

“Much lower blood pressure targets are required and multiple drugs need to be used right from the start if patients are to achieve the largest reduction in the risks of stroke and heart attack.”

In 2015, it was reported that in England, high blood pressure affected more than one in four adults (31 per cent of men; 26 per cent of women) – around 13.5 million people – and contributed to 75,000 deaths.

The draft guideline is open for public consultation until 23 April. Final guidance is expected to be published in August.