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The NICE/BHS hypertension guidelines were updated in August 2011, and one of the significant changes was the criteria for diagnosis of hypertension and initiation of therapy. The purpose of this study was to measure the impact of this change in guidelines on referrals to a tertiary care hypertension clinic four years post-implementation, at the same time investigating the consequent effect on care delivery.

Design and method:

All new referrals to the Glasgow Blood Pressure Clinic (GBPC) between 01/05/2014 to 29/02/2016 were reviewed and clinical data extracted from case records (NICE group). Historical data on new referrals from January 2007 to December 2008 were extracted from the GBPC database (Pre-NICE group). Chi-square and T-tests were used as appropriate.


The NICE and Pre-NICE groups comprised 712 and 801 patients respectively. There were no significant age or sex differences between the cohorts. The proportion of untreated patients was significantly higher in NICE compared to Pre-NICE (39% versus 25%, p < 0.0001). Among the untreated patients, SBP and DBP were significantly lower in NICE compared to Pre-NICE (p < 0.04). DBP was also significantly lower in the overall NICE population compared to Pre-NICE (p < 0.001). ABPM was done on 437 (61%) NICE patients, and the proportion of normotension, masked HTN, white-coat HTN and HTN were 24%, 9%, 25%, 42% respectively among all referred patients and 29%, 9%, 27%, 35% among the untreated subgroup. Compared to the previous BHS guidelines, the current NICE/BHS guidelines 2011 resulted in 17% fewer patients being commenced on antihypertensive treatment (p < 0.0001), which may partly reflect the increase in the number of referrals for ABPM for diagnostic purposes.


The new NICE/BHS guidelines have resulted in a change in profile of patients being referred to a tertiary care clinic in Glasgow, highlighting a need to review the speciality service to ensure that limited resources for the care of more complex patients are not overwhelmed.

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