BMJ  2004;329:1289 (27 November), doi:10.1136/bmj.329.7477.1289-a

Letter

NICE and BHS guidelines on hypertension differ importantly

The first 150 words of the full text of this article appear below.

EDITOR—The NICE guidelines on hypertension remind the public that hypertension is a major risk factor for cardiovascular diseases. Their added value to those who manage hypertension is, however, unclear, given the recent national and international guidelines from experts and primary care doctors with an interest in hypertension.^1-3 The NICE guidance is largely consistent with these guidelines, but it differs from those of the British Hypertension Society in several important ways, thereby leading to confusion and potentially suboptimal management of hypertension. However, if both sets of guidelines improve the control of blood pressure the differences between guidelines will become less critical.

The NICE recommendation to treat hypertension initially with a thiazide-like diuretic irrespective of age, ethnic group, and whether isolated systolic hypertension is present or not is not supported by best evidence. Small crossover studies and large randomised trial data show differential effects on blood pressure with different antihypertensive . . . [Full text of this article]

Imperial College, London W2 1PG n.poulter@imperial.ac.uk

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