National Institiue for Health and Clinical Excellence

Annual Review - 2011/2012
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Guidelines for delivering the highest quality healthcare

Case study: hypertension guideline

NICE clinical guidelines provide recommendations to the NHS on the appropriate treatment and care of people with specific diseases and conditions.

Based on the best available evidence, the clinical guidelines aim to assist health professionals in their work, help patients make informed decisions about their care, and improve communication between patients and health professionals.

In 2011/2012, NICE produced 19 clinical guidelines, taking the number published in total to 139.

Among the topics covered this year were guidelines on:

  • patient experience in adult NHS services
  • service user experience in adult mental health
  • ovarian cancer
  • lung cancer
  • hip fracture
  • recognition, referral and diagnosis of autism in children and young people
  • caesarean section.

This year the Centre for Clinical Practice, which produces clinical guidelines, was expanded following the integration of the former National Prescribing Centre and the management of the contract with the British National Formulary.

As a result, NICE now offers advice and support for delivering quality, safety, and efficiency in the use of medicines through the new NICE medicines and prescribing centre.

The centre provides a suite of advice products and information, including summaries of the best available evidence for selected new medicines deemed significant to the NHS, and advice on the use of unlicensed and off-label medicines.

In June 2011, NICE clinical guidelines earned international praise for being among the most 'trustworthy' in the world, in an editorial in the US journal Annals of Internal Medicine.

The editorial praised the way NICE produces guidance and suggested that its guideline for the prevention of delirium comes close to meeting standards that should be met by all trustworthy guidelines.

Case study - hypertension clinical guideline

In August 2011, NICE published an updated clinical guideline on the management of high blood pressure, known as hypertension, which called for a radical change in practice for diagnosis of the condition.

In the previous guideline, it was recommended that anyone suspected of having hypertension was diagnosed by a GP with an inflatable arm cuff. They were then invited back to the surgery for additional readings so that average measurements could be calculated.

The new guideline recommended that hypertension should be made using 24-hour ambulatory blood pressure monitoring (ABPM), which should be offered to patients if their clinic blood pressure is 140/90 mmHg or higher.

This involves monitoring and recording blood pressure throughout the day and night using a type of blood pressure monitor that straps around the waist.

In future, as more people benefit from accurate diagnoses using ABPM, the NHS is expected to save approximately £4 million within three years of the guideline being published, by not providing hypertensive treatment for people who are not hypertensive.

These savings are expected to rise to a figure £10.5 million within five years.

Professor Richard McManus, Professor of Primary Care Cardiovascular Research and member of the Guideline Development Group, commented:

"These guidelines will mark a significant change in the way that we diagnose hypertension.

"The use of ambulatory monitoring will ensure quicker and more accurate diagnosis that will be better for patients and better for the NHS.

"This represents an exciting advance which I am sure will be taken up internationally."