The UK’s cost-effectiveness body, the National Institute for Health and Clinical Excellence, this morning ruled that patients with high blood pressure should no longer be treated with cheap generic beta-blockers – saying that other treatments are more effective, particularly in the elderly, and that beta-blockers have been linked to an “unacceptable risk” of developing type 2 diabetes.
Although the guidance, which was drawn up alongside the British Hypertension Society, was not due to be looked at again until 2009, the Institute says fresh evidence spurred it to re-evaluate its recommendations – originally published in August 2004.
Hypertension is a massive problem in the UK with some 40% of adults in England and Wales – the countries covered by NICE – living with the condition, a so-called ‘silent disease’ linked to significant morbidity and mortality from heart attack, stroke, chronic kidney disease and other vascular conditions. And it is not cheap. In 2001, the last data available, the National Health Service funded 90 million prescriptions to lower blood pressure representing almost 15% of the total bill for primary care drugs.
Specifically, NICE says patients with high blood pressure under the age of 55 should now be treated in the first instance with an ACE inhibitor. But for those over the age of 55 and black patients, the first port of call should be a calcium channel blocker or thiazide-type diuretic.
It may be seen as a bold decision for the Institute, with many primary care trusts already facing financial difficulties. But Professor Bryan Williams, a member of the guideline development group, said: “It is no longer a case of ‘can we afford to do it’ but more ‘can we afford not to do it’.” Current blood pressure therapy costs the NHS just under £410 million every year and NICE estimates using the newer treatments will add another £58 million to this figure. However, the potential savings from cutting the number of macrovascular complications – particularly strokes – is put at an additional £280 million, with a net saving to the health service of £222 million.
Professor Peter Littlejohns, clinical and public health director at NICE, said: "It is unusual for NICE to consider reviewing its guidance ahead of its planned review date. In this case, however, because significant new data became available, we took the decision to consider that data as part of a limited review." For example, Pfizer’s calcium channel blocker Norvasc (amlodipine) showed better blood pressure lowering in the ASCOT trial, in combination with an ACE inhibitor, than a beta-blocking regimen. It also resulted in an 11% reduction in mortality, leading to calls for a change to traditional blood pressure lowering treatment regimens.
High blood pressure is the biggest preventable cause of death and disability in the UK through heart attacks, strokes and heart failure.