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NICE encourages BP home monitoring

A mobile device that records blood pressure over 24 hours will be offered to patients in England and Wales to counteract 'white coat' hypertension.

The move is being recommended by NHS drugs watchdog, the National Institute for Health and Clinical Excellence (NICE) and could save the NHS up to £10.5m a year.

The BBC reports a quarter of patients suffer from 'white coat' hypertension, where a person's blood pressure is temporarily raised due to the stress involved in visiting a GP.

This can lead to misdiagnosis and a patient being given unnecessary drugs.

The cost of implementing the ambulatory equipment is reported to be around £2.5m and will take approximately a year. However, Professor Bryan Williams, chairman of NICE's Guideline Development Group, told the BBC all introductory costs would be "upfront".

"When you offset that against the reduced treatment costs of people who don't require treatment, and the reduced number of visits to doctors, we estimate that the NHS within about four or five years will save £10m," said Williams.

"It's a win-win situation for patients because it's a better way of making a diagnosis and the NHS actually saves money."

It is estimated one in ten GPs already offer such mobile devices, either directly or through referring patients to a hospital specialist.

High blood pressure is a leading risk factor for heart disease or strokes and costs the NHS £1bn every year in drugs alone. Cathy Ross, senior cardiac nurse at the British Heart Foundation, told the BBC the number of people with high blood pressure is "staggering".

She claims 12 million people in the UK have already been diagnosed with the condition and a further 5.7 million are unaware they have it.

"This new guidance will refine the way we test and treat people for hypertension, particularly by helping to identify people suffering from 'white coat hypertension'," said Ross.

"It doesn't mean that current methods aren't working, only that they can be improved further."

British Heart Foundation

Your comments (terms and conditions apply):

"I think that the concept is good but in deprived areas handing out BP monitors will not be an option. The reason being is that they will not be seen again! We have looked at other options such as a deposit towards the monitor that can be collected when the machine is handed in. However, most of our patients have enough for their cigarettes and that is it!!! If anyone has other thoughts on how to manage in deprived areas I would be
very grateful for their thoughts" - Carol Ball, Devon

"I am involved in caring for people with hypertension and their monitoring of course there are risks but home monitoring as part of their care is an added tool. I encourage my patients to montior their BP at home and bring a copy of their readings and their monitor to their appointment so we can compare my reading in clinic with their monitor. It allows patients to be pro-active in their own care. Before they leave they are always
advised if home readings are higher than normal to return to the clinic" - Carol Malone, Glasgow

"I think this is a good concept clear guidance is needed to make sure that patients are not given BP medication unnecessarily because a lot of GPs tend to give medication without a clear reading. BP changes throughout the day and this is why patients need to be monitored effectively" - Lakbir, West Midlands

"The way to monitoring BP is good that may avoid the cost of drugs as well as patient's accurate BP condition" - Naheeda Philip

"We used to do a lot more 24hr BPs in my area than we do now; in fact, I had 24hr monitoring myself 3 years ago which reassured me that I am not hypertensive, even though my random BPs were elevated substantially. White coat is real, and I always treat BPs I take in surgery with initial scepticism, until further monitoring has taken place when the patient is
more relaxed. I don't know what the excuses are in my area for not referring patients for 24hr ambulatory BP monitoring but I suspect it has to do with money, anti-hypertensives and occasional visit for BP with a practice nurse are relatively cheap in comparison to referral in the short term. Also I think many GPs are forced to look at the short term only in this culture of cuts, and investing in expensive computer equipment and time for staff to spend initiating the monitoring and then reading the results is increasingly becoming prohibitive. It's about time the DH looked at the long-term effects in regard to this, and issued more funding for 24hr
monitoring, rather than lurching from one financial restraint to another" - BL, Wilts

"The people who will benefit from this are already visiting their doctor. We need to educate the general public to play a greater part in their own healthcare and teach them to correctly use a blood pressure monitor at home. These are far cheaper, the 24 hour monitor could then be used to double-check when people report to their doctor with high readings. Also there needs to be far more education about what causes high blood pressure, how you can help to prevent it and the very real risk of stroke associated with it" - Eve Knight, Kent
"The only risk is if the patient is not aware of the correct technique to measure the blood pressure at home or there are times when blood pressure will go up, for example, after having tea or cofee, only then the reading might not be correct. Also, if the equipment is not regularly calibrated the observations might not be correct. Sometimes using digital
blood pressure monitors or the one used with wrist might be giving inaccurate observations" - Satish Mittal, London

"Is this supposed to be new? To the public this could suggest we take a random reading and decide someone is hypertensive. Do they think we do not already consider white coat hypertension? 24 hour BP monitoring has been used increasingly in my area for many years and all practices have been supplied with one and the software to download results. I think we should be worrying more about the undiagnosed and untreated people out there" - Rhona Aikman

"There is no risk monitoring your BP at home, the risk is having your BP monitored at the doctors. My BP at the doctors was 158/80, so he put me on BP pills....before going to my doctors I measured my own BP, it was always 138/80 or 140/79 each day which is very good as I am 69 years old, so I could be on BP medication for nothing, just thinking of going to the doctors pushes my BP up" - Graham, Stafforshire 

"I think this a good idea as I myself suffer with this White coat syndrome and would like to give it a go to see if I could reduce my prescription medicines" - Jt Came, Lincs