8.2 Secondary prevention using drugs
Extensive research has been carried out into the use of drugs to help limit damage and minimise deterioration of an established heart or circulatory condition. The use of four main drug categories together reduces the risk of an MI, a stroke or cardiovascular disease death over the next two years by 75 per cent in patients with previous coronary heart disease or stroke (2002 figures from Mackay and Mensah, 2004). Such secondary prevention of cardiovascular diseases has been formalised into a set of recommendations for doctors in the UK by the National Institute for Health and Clinical Excellence (NICE). This is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health in the population.
NICE produces guidance in three areas of health (public health, health technologies and clinical practice) through centres of excellence. The Centre for Clinical Practice develops the clinical guidelines or recommendations, based on the best available scientific evidence, on the appropriate treatment and care of people with specific diseases and conditions, such as hypertension, chronic heart failure and diabetes. To look at one in more detail, read the following summary on the treatment of high blood pressure and then work through the flowchart in Figure 13.
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The NICE clinical guideline on hypertension (National Institute for Health and Clinical Excellence, 2007) covers:
how doctors should find out whether someone has high blood pressure
how doctors should assess someone's risk of developing problems with their heart or blood vessels, such as a heart attack or stroke
how lifestyle factors such as smoking, diet and exercise can affect blood pressure
the use of medicines to lower blood pressure
how high blood pressure should be monitored.
These recommendations apply to primary care – treatment by a GP or practice nurse. They do not apply to hospital care. This guideline does not look at screening for hypertension (routine checking of blood pressure in healthy people to detect early disease), hypertension during pregnancy or the specialist management of secondary hypertension (where the high blood pressure is happening because of another medical problem).