부산대학교 도서관

OBJECTIVE:: In 2011, National Institute for Health and Care Excellence (NICE) guidelines recommended routine use of out-of-office blood pressure monitoring for the diagnosis of hypertension due to evidence of cost effectiveness. Critics were concerned this would increase cardiovascular morbidity. We aimed to assess the impact of this change on the incidence of hypertension, out-of-office monitoring and cardiovascular morbidity.(Figure is included in full-text article.) DESIGN AND METHOD:: This was a cohort study and interrupted time series analysis including 3,937,191 adults registered between 1/4/2006 and 31/3/2017 from English general practices within the Clinical Practice Research Datalink (CPRD) linked to inpatient hospital, mortality and deprivation data. The changes associated with the NICE hypertension guideline in 2011 were assessed in terms of their impact on: Incidence of hypertension (primary outcome, determined from diagnostic codes), rate of out-of-office monitoring and major cardiovascular events (cardiovascular death, myocardial infarction, or stroke). RESULTS:: Median follow-up was 4.2 years, 49% were male and mean age was 39.7 years. The incidence of hypertension for all adults fell from 2.1 per 100 person-years in April 2006 to 1.4 per 100 person-years in March 2017. The change in guidance in 2011 was not associated with an immediate change in hypertension incidence (change in rate = 0.01 per 100 person years; 95% CI [−0.18 to 0.20]) but was associated with a levelling out of the downward trend observed from 2006 to 2011 (change in yearly trend =0.09; 95% CI [0.04 to 0.15]) [Figure]. The rate of ambulatory BP monitoring increased significantly in 2011/12 (change in rate =0.52 per 100 person years; 95% CI [0.43 to 0.60]). The rate of cardiovascular events remained unchanged (change in rate =−0.02, 95% CI [−0.05 to 0.02]). CONCLUSIONS:: Changes to the NICE hypertension guideline in 2011 were not associated with an increase in cardiovascular events, at least in the short term. The incidence of hypertension which had been declining levelled off. Recorded out-of-office monitoring increased significantly although from a low base compared to clinic monitoring. International guidelines should continue to recommend out-of-office monitoring for diagnosis of hypertension.