The recent updated guidance from the National Institute for Health and Clinical Excellence (NICE) on the management of hypertension in adults will have far reaching implications for day to day practice in the United Kingdom.1 2 The guidelines were developed in partnership with the British Hypertension Society and have 65 recommendations, 36 of which are new, with 12 listed as key priorities. Although these figures may seem daunting, closer scrutiny shows that most of the changes have evolved from previous guidelines and should be relatively straightforward to incorporate into clinical practice.

For the first time targets have been partially relaxed. Admittedly this applies only to people aged 80 or more, in whom a target blood pressure lower than 150/90 mm Hg is recommended. The previous target of 140/90 mm Hg is retained for everyone else, and this will continue to be a challenge in primary care.3 However, the guidelines clearly state that individual needs and preferences must be taken into account.1 They acknowledge that a balance must be struck between achieving targets and the realities of adherence to treatment and possible distressing side effects—particularly symptoms of postural hypotension.

The most noticeable change with …