Diagnosis and management of hypertension in adults: NICE guideline update 2019

In August 2019, the National Institute for Health and Care Excellence (NICE) released its new hypertension guidelines.1 This article highlights the key recommendations and changes since 2011. The diagnostic threshold for hypertension remains 140/90 mmHg on clinic blood pressure (BP). As previously, it is recommended that diagnosis is based on out-of-office measurement, given the risk of white-coat hypertension, defined as a difference of >20/10 mmHg between clinic readings and average daytime home or ambulatory measurements. The gold standard is ambulatory BP monitoring (ABPM) but, as this is not suitable or tolerated by everyone, home BP monitoring (HBPM) is offered as an alternative. For HBPM, patients should be advised to take at least two recordings, 1 minute apart, twice a day for 4 to 7 days. The first day of readings should be discounted and the mean of the remaining readings used. If the mean BP is close to the diagnostic threshold, ABPM may be needed to confirm the diagnosis, particularly in younger people (for example, aged <60 years) where the implications of a new hypertension diagnosis may be more significant. The diagnostic threshold for ABPM or HBPM remains 135/85 mmHg. Standing BP should be measured in those with type 2 diabetes, aged ≥80 years, and patients with symptoms of postural hypotension. The standing BP should be measured after the person has been standing for at least 1 minute. Where there …