Education and debate

British Hypertension Society guidelines for hypertension management 1999: summary

BMJ 1999; 319 doi: 10.1136/bmj.319.7210.630 (Published 4 September 1999)
Cite this as: BMJ 1999;319:630

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  1. Lawrence E Ramsay, professor of clinical pharmacology and therapeuticsa,
  2. Bryan Williams, professor of medicine (bw17@leicester.ac.uk)b,
  3. G Dennis Johnston, professor of clinical pharmacologyc,
  4. Graham A MacGregor, professor of cardiovascular medicined,
  5. Lucilla Poston, professor of fetal medicinee,
  6. John F Potter, professor of medicine for the elderlyb,
  7. Neil R Poulter, director, cardiovascular studies unitf,
  8. Gavin Russell, consultant renal physiciang
  1. a University of Sheffield, Sheffield S10 2TN
  2. b University of Leicester School of Medicine, Leicester Royal Infirmary, Leicester LE2 7LX
  3. c Queen's University of Belfast, Belfast BT7 1NN
  4. d Department of Medicine, St George's Hospital, London SW17 0RE
  5. e Department of Obstetrics and Gynaecology, St Thomas's Hospital, London SE1 7EH
  6. f Imperial College School of Medicine, London W2 1NY
  7. g North Staffordshire Royal Infirmary, Stoke on Trent ST4 7LN
  1. Correspondence to: B Williams
  • Accepted 11 August 1999

This article summarises the new British Hypertension Society guidelines for management of hypertension, which have been published in full.1 Since the previous guidelines 2 3 much new evidence has emerged on optimal blood pressure targets4; management of hypertension in diabetic patients4–7; treatment of isolated systolic hypertension8; comparison of the antihypertensive efficacy and tolerability of different drug classes9–11; the role of non-pharmacological measures for prevention 12 13 and treatment of hypertension14; and additional benefits associated with the use of aspirin and statins.

Of concern is that national surveys continue to reveal incomplete detection, treatment, and control of hypertension.15 Furthermore, treated hypertensive patients still die prematurely from cardiovascular disease.16 These guidelines aim to present the best currently available evidence on hypertension management and their implementation.

Summary points

Use non-pharmacological measures in all hypertensive and borderline hypertensive people

Initiate antihypertensive drug treatment in people with sustained systolic blood pressure ≥160 mm Hg or sustained diastolic blood pressure ≥100 mm Hg

Decide on treatment in people with sustained systolic blood pressure between 140 and 159 mm Hg or sustained diastolic blood pressure between 90 and 99 mm Hg according to the presence or absence of target organ damage, cardiovascular disease, diabetes, or a 10 year coronary heart disease risk ≥15% according to the Joint British Societies coronary heart disease risk assessment programme or risk chart

Optimal blood pressure treatment targets are systolic blood pressure <140 mm Hg and diastolic blood pressure <85 mm Hg; the minimum acceptable level of control (audit standard) recommended is <150/<90 mm Hg

In the absence of contraindications or compelling indications for other antihypertensive agents, low dose thiazide diuretics or β blockers are preferred as first line treatment for the majority of hypertensive people; compelling …

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