Supplemental Digital Content is available in the text. In recent years, national and international guidelines have recommended the use of out-of-office blood pressure monitoring for diagnosing hypertension. Despite evidence of cost-effectiveness, critics expressed concerns this would increase cardiovascular morbidity. We assessed the impact of these changes on the incidence of hypertension, out-of-office monitoring and cardiovascular morbidity using routine clinical data from English general practices, linked to inpatient hospital, mortality, and socio-economic status data. We studied 3 937 191 adults with median follow-up of 4.2 years (49% men, mean age=39.7 years) between April 1, 2006 and March 31, 2017. Interrupted time series analysis was used to examine the impact of changes to English hypertension guidelines in 2011 on incidence of hypertension (primary outcome). Secondary outcomes included rate of out-of-office monitoring and cardiovascular events. Across the study period, incidence of hypertension fell from 2.1 to 1.4 per 100 person-years. The change in guidance in 2011 was not associated with an immediate change in incidence (change in rate=0.01 [95% CI, −0.18–0.20]) but did result in a leveling out of the downward trend (change in yearly trend =0.09 [95% CI, 0.04–0.15]). Ambulatory monitoring increased significantly in 2011/2012 (change in rate =0.52 [95% CI, 0.43–0.60]). The rate of cardiovascular events remained unchanged (change in rate =−0.02 [95% CI, −0.05–0.02]). In summary, changes to hypertension guidelines in 2011 were associated with a stabilisation in incidence and no increase in cardiovascular events. Guidelines should continue to recommend out-of-office monitoring for diagnosis of hypertension.

中文翻译：

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国家高血压指南变更对英国高血压管理和结果的影响

文本中提供了补充数字内容。近年来，国家和国际指南建议使用门诊血压监测来诊断高血压。尽管有成本效益的证据，但批评者表示担心这会增加心血管疾病的发病率。我们使用来自英国全科诊所的常规临床数据，与住院、死亡率和社会经济状况数据相关联，评估了这些变化对高血压发病率、办公室外监测和心血管疾病发病率的影响。我们研究了 2006 年 4 月 1 日至 2017 年 3 月 31 日期间 3 937 191 名成人，中位随访时间为 4.2 年（49% 为男性，平均年龄 = 39.7 岁）。间断时间序列分析用于检查 2011 年英国高血压指南的变化对高血压发病率（主要结果）的影响。次要结果包括办公室外监测和心血管事件的发生率。在整个研究期间，高血压发病率从每 100 人年 2.1 人降至 1.4 人。2011 年指南的变化与发病率的立即变化无关（发生率变化 = 0.01 [95% CI，-0.18-0.20]），但确实导致下降趋势趋于平稳（年度趋势变化 = 0.09 [95% CI，0.04–0.15]）。2011/2012 年动态监测显着增加（变化率 =0.52 [95% CI，0.43–0.60]）。心血管事件发生率保持不变（发生率变化 =-0.02 [95% CI, -0.05–0.02]）。总之，2011 年高血压指南的变化与发病率稳定和心血管事件没有增加有关。指南应继续推荐在办公室外监测高血压的诊断。