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Education And Debate

British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary

BMJ 2004; 328 doi: (Published 11 March 2004) Cite this as: BMJ 2004;328:634

This article has a correction. Please see:

  1. Bryan Williams (, professor of medicine1,
  2. Neil R Poulter, professor of preventive cardiovascular medicine2,
  3. Morris J Brown, professor of clinical pharmacology3,
  4. Mark Davis, general practitioner4,
  5. Gordon T McInnes, professor of clinical pharmacology5,
  6. John F Potter, professor of ageing and stroke medicine6,
  7. Peter S Sever, professor of clinical pharmacology2,
  8. Simon McG Thom, reader in medicine2

    the BHS guidelines working party, for the British Hypertension Society

  1. 1 Department of Cardiovascular Sciences, University of Leicester, Clinical Sciences Building, Leicester Royal Infirmary, Leicester
  2. 2 International Centre for Circulatory Health, Imperial College London and St Mary's Hospital, London
  3. 3 Clinical Pharmacology Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge
  4. 4 Moorfield House Surgery, Garforth, Leeds
  5. 5 Section of Clinical Pharmacology and Stroke Medicine, Division of Cardiovascular and Medical Sciences, Gardiner Institute, Western Infirmary, University of Glasgow, Glasgow
  6. 6 continued over Ageing and Stroke Medicine Section, Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester
  1. Correspondence to: B Williams


    Much new evidence has emerged on the importance of blood pressure as a risk factor for cardiovascular disease; the importance of lifestyle measures for the prevention and treatment of hypertension; the efficacy and safety of different drug classes; management of hypertension in groups at higher risk, including people with diabetes; the importance of assessing the total risk of cardiovascular disease; and additional benefits associated with the use of statins.

    Concern remains that national surveys continue to show substantial underdiagnosis, undertreatment, and poor rates of blood pressure control in the United Kingdom.1 A key reason for this is the predominant use of monotherapy by most doctors.1 To improve this suboptimal treatment, the British Hypertension Society recommends a treatment algorithm based on the AB/CD rule.2

    Treatment of blood pressure alone will leave many hypertensive patients at unacceptably high risk of cardiovascular complications and death. This guideline reinforces the view that doctors should not focus solely on blood pressure but must also formally assess total risk of cardiovascular disease and use multifactorial interventions, including statins and aspirin, to reduce it. Most management of blood pressure and risk of cardiovascular disease will take place in primary care, and these guidelines are intended for general practitioners, practice nurses, and generalists in hospital practice. Detailed advice on implementation and the implications of the national service frameworks and the general medical services contract are contained in the full document (

    These guidelines have been prepared by the guidelines working party of the British Hypertension Society on behalf of the society. The working party reviewed new data that have become available since the previous guidelines were published4 and amended the recommendations accordingly. Drafts of the full document were improved by consultation with …

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