Abstract

In June 2006, the National Institute for Health and Clinical Excellence (NICE) updated its recommendations on the management of patients with hypertension (published in 2004), in light of “significant new data” relating to drug treatment.1^,2 The update, published in collaboration with the British Hypertension Society (BHS), recommended first-line use of a calcium-channel blocker or a thiazide-type diuretic in patients aged over 55 years or an ACE inhibitor in those aged under 55 years, and advised that beta-blockers should no longer be used for routine initial therapy.1 Recently published data from England suggest that primary care prescribing has changed in line with this new guideline.3 However, interpretation of the evidence that underpins some of the key recommendations is open to debate, particularly as there are differences from some other major guidelines in the recommendations for first-line therapy. Here we consider the updated NICE guideline, the rationale for its treatment recommendations, and the subsequent change in clinical practice. In particular, we focus on the initial drug management of adults without conditions such as diabetes mellitus or coronary heart disease that would in themselves be a key determinant of management.