Forty per cent of adults suffer from high blood pressure but thousands are not receiving proper treatment. PATRICIA ALLEN reports

THOUSANDS of people are not being treated properly for a common illness that is a "silent killer" in Britain. It is estimated that 40 per cent of adults in England and Wales suffer from high blood pressure or hypertension, with the numbers increasing with age.

And just a third of all sufferers are aware they have the condition, while another third are not being treated for it and others "are not being treated properly or controlled to recommended targets," according to Professor Bryan Williams of the University Hospitals NHS Trust, Leicester.

The symptoms are often only noticed by chance and after it has caused long-term damage or increased the risk of heart and kidney diseases, stroke and diabetes.

Prof Williams was part of a National Institute of Clinical Excellence (NICE) review of evidence on the treatment of hypertension sufferers which found a need for improved accuracy of diagnosis and quality of treatment.

He says: "Hypertension is often referred to as the silent killer because it often does not present symptoms until it has already taken hold and caused damage."

Under new guidelines announced today by NICE and the Newcastle Guideline and Development Research Unit, doctors will be asked to spearhead a regime of prescribing blood pressure lowering drugs alongside preventative treatments and assessment.

No figures are currently available for the added cost of the extra prescriptions or the amount that could be saved in preventing illnesses from developing.

Dr Wendy Ross, a GP member of the review team, says the guidelines will probably lead to more patients taking "three or four drugs at a time" but the end result could be more people with controlled blood pressure.

The cost to the NHS of prescriptions for anti-hypertensive drugs was around £840 million in 2001, nearly 15 per cent of the total annual cost of all primary care drugs.

Hypertension is often inadequately treated and is a major contributory factor in cardiovascular diseases which account for 30 per cent of all deaths and four million bed days annually - or eight per cent of the total capacity of the NHS.

The recommendations say hypertension sufferers should potentially face a range of treatments including having their blood pressure measured, an assessment of their cardiovascular risk and drug therapy. They will also be given lifestyle advice and be told to consider stopping smoking, improving their diets, exercising more and drinking less caffeine.

Drug therapy should normally begin with a low dose thiazide-type diuretic. If necessary a beta blocker or an Ace-inhibitor could be added and finally a dihydrophyridine calcium-channel blocker could be prescribed. Annual reviews of blood pressure levels are also recommended.

Andrew Dillon, NICE's chief executive, says: "Hypertension can be treated, in most cases, successfully. The fact that a significant proportion of people with this condition remain undiagnosed, coupled with evidence that suggests a high incidence of sub-optimal treatment, and therefore poor rates of blood pressure control, for those who are diagnosed, make this guideline particularly significant." The Association of the British Pharmaceutical Industry (ABPI) said the number of prescriptions for anti-hypertension medicines had increased five-fold over the last decade.

There has been a 27 per cent fall in the number of hospital patient-days spent treating hypertension from 125,000 in 1991 to 91,000 by the end of 1992.

ABPI director general Dr Richard Barker says: "This new guidance from NICE demonstrates once again that early and tight management of a disease results in better health for patients, reduces the number of hospital stays and frees up capacity for the NHS. Medicines have a key role to play in achieving these aims."