New blood pressure checks at home

24 August 2011 Last updated at 07:01 GMT By Helen Briggs Health editor, BBC News website Patient Sheila Milson tries out the blood pressure recording device. Prof Mark Caulfield, from Queen Mary University of London, explains how works.

Patients thought to have high blood pressure should have the diagnosis confirmed at home, according to new guidelines.

Patients in England and Wales will be offered extra checks using a mobile device that records blood pressure over 24 hours, says the watchdog NICE.

A quarter of patients may find visiting a GP stressful, leading to misdiagnosis and being given drugs they do not need.

The move could save the NHS £10.5m a year, predictions suggest.

High blood pressure (blood pressure of 140/90mmHg or more) affects about a quarter of all adults in the UK. It is a leading risk factor for heart disease or stroke and costs the NHS about £1bn a year in drugs alone.

Currently, most patients found to have high blood pressure for the first time are given a formal diagnosis if their blood pressure is raised at two subsequent visits to the doctor.

They may then be prescribed medication to lower their blood pressure.

Day and night

Research suggests, however, that about a quarter of patients actually have "white coat" hypertension - where blood pressure is raised temporarily due to stress.

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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”

End Quote Cathy Ross Senior cardiac nurse at the British Heart Foundation Now, the National Institute for Health and Clinical Excellence (NICE) has advised doctors in England and Wales to move towards "ambulatory" monitoring of patients at home, using a device that automatically takes blood pressure readings every 30 minutes day and night.

Around one in 10 GPs are already offering ambulatory monitoring, either directly or by referring patients to a hospital specialist.

The new guidelines were issued at the same time as the publication of a research study in The Lancet.

One of the authors of the paper, Professor Richard McManus of the University of Birmingham, said: "This research shows that ambulatory blood pressure monitoring at the time of diagnosis of high blood pressure would allow better targeting of treatment and is cost-saving.

"Ambulatory monitoring is already available in some general practices and we have shown that its widespread use would be better for both patients and the clinicians looking after them.

"Treatment with blood pressure lowering medication is usually lifelong and so it is worth getting the decision to start right in the first place."

It is expected to take about a year to implement the advice at a net cost of about £2.5m. However, in the long-term the costs will be recouped, say experts, eventually saving about £10.5m a year.

'More accurate'

Cathy Ross, senior cardiac nurse at the British Heart Foundation, said the number of people with high blood pressure in the UK was "staggering".

"Some 12 million people are diagnosed with the condition and it is estimated another 5.7 million people have it but are unaware. It's a major risk factor for heart disease and strokes so it's crucial we do all we can to get people diagnosed and properly treated as soon as possible.

"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'.

"It doesn't mean that current methods aren't working, only that they can be improved further. Anyone currently concerned about their blood pressure or treatment should speak to their GP or practice nurse."

Professor Bryan Williams from the University of Leicester, chairman of NICE's Guideline Development Group, told the BBC there would be an "upfront cost" of introducing the ambulatory equipment.

But he added: "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.

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

British Hypertension Society president Professor Mark Caulfield said the move was supported by research.

He said: "We've recommended that if high readings are found in the practice, that a 24-hour blood pressure monitor is worn because we found that the evidence now makes it very clear to us that this is a much more precise way of diagnosing high blood pressure."

In response to the new guidelines, Health Minister Anne Milton said: "These guidelines show that the use of innovations such as ambulatory monitors can provide more accurate blood pressure readings for patients as they go about their daily lives.

"This is not only better for patients, but also a better use of NHS resources."

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Fewer 'face child worker checks'

11 February 2011 Last updated at 08:32 GMT The government says the system of checks on child workers has become too bureaucratic Millions of people in England and Wales who work or volunteer with children and vulnerable adults will no longer need criminal record checks, ministers say.

Deputy Prime Minister Nick Clegg said he wanted to lift the atmosphere of suspicion and distrust cast over adults who simply wanted to help.

But some child protection campaigners fear it will be easier for adults in positions of trust to abuse children.

The change is part of the government's Freedoms Bill, being unveiled later.

It also includes limits on police stop and search powers, ends indefinite storage of innocent people's DNA and gives residents more control over CCTV.

Mr Clegg said: "Of course we need checks on those people who are working regularly with children and vulnerable adults but not everybody who is volunteering, often on an irregular basis, simply trying to help out. We want to get it into proportion.

"Most people accept we were treated with too much distrust and suspicion and too many people were almost treated as if they were criminals by Labour in recent years.

"It's still going to be a scheme of some considerable size but one which does not cast that atmosphere of distrust over adults who are simply trying to do their best by their own children, by children in their own community."

'Streamlined' The new bill calls for a merging of the Criminal Records Bureau (CRB) and Independent Safeguarding Authority to form "a streamlined new body providing a proportionate barring and criminal records checking service".

That body will provide what ministers say will be a more "proportionate" checking service for about 4.5m people who work "closely and regularly" with children or vulnerable adults.

Teachers will continue to be vetted - but those who do occasional, supervised volunteer work will not.

Job applicants will also be able to see the results of their criminal record check before their prospective employer so mistakes can be corrected.

And the bill promises a "portability of criminal records checks between jobs to cut down on needless bureaucracy" and to stop "employers who knowingly request criminal records checks on individuals who are not entitled to them".

'Completely wrong'

Home Secretary Theresa May suspended Labour's Vetting and Barring scheme - set up in 2009 after an inquiry into the murders of the Soham schoolgirls Holly Wells and Jessica Chapman by school caretaker Ian Huntley - in June last year and a review was carried out.

Children's minister Tim Loughton said: "The new system will be less bureaucratic and less intimidating. It will empower organisations to ask the right questions and make all the appropriate pre-employment checks, and encourage everyone to be vigilant.

"Protecting children and keeping them safe remains our top priority, but it's also important that well meaning adults are not put off working or volunteering with children."

Children's charity Barnardo's said the move was "a victory for common sense".

Chief executive Anne Marie Carrie said: "There is already enough safeguarding in place for people who have unsupervised, substantial access to children.

"This approach will make it easier for grandparents, parents and neighbours, who should be able to play an important role in a child's life without unnecessary red tape."

However, former police detective and child protection expert Mark Williams Thomas has told the BBC he believes the changes will give offenders more opportunities to gain access to children.

"If it was about keeping children safe then this vetting scheme would continue. CRB would continue in the fashion it is," he said.

"This is simply about saving money, it's about scrapping any ideas that Labour had previously. Whoever is advising the government on this position has got it completely wrong.

"Offenders are very deviant, they're very calculated and they will seek out opportunities and they will go to where those checks don't exist."

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