Blood pressure guidelines - where are we now?

doi:10.1136/dtb.2008.09.0020

Drug and Therapeutics Bulletin 2008;46:65-69; doi:10.1136/dtb.2008.09.0020

Blood pressure guidelines – where are we now?

Relevant BNF section: 2.2, 2.4, 2.5, 2.6

In June 2006, the National Institute for Health and ClinicalExcellence (NICE) updated its recommendations on the managementof patients with hypertension (published in 2004), in lightof "significant new data" relating to drug treatment.^1,2 Theupdate, published in collaboration with the British HypertensionSociety (BHS), recommended first-line use of a calcium-channelblocker or a thiazide-type diuretic in patients aged over 55years or an ACE inhibitor in those aged under 55 years, andadvised that beta-blockers should no longer be used for routineinitial therapy.¹ Recently published data from England suggestthat primary care prescribing has changed in line with thisnew guideline.³ However, interpretation of the evidence thatunderpins some of the key recommendations is open to debate,particularly as there are differences from some other majorguidelines in the recommendations for first-line therapy. Herewe consider the updated NICE guideline, the rationale for itstreatment recommendations, and the subsequent change in clinicalpractice. In particular, we focus on the initial drug managementof adults without conditions such as diabetes mellitus or coronaryheart disease that would in themselves be a key determinantof management.