Intended for healthcare professionals


NICE hypertension guideline 2011: evidence based evolution

BMJ 2012; 344 doi: (Published 13 January 2012) Cite this as: BMJ 2012;344:e181
  1. Richard J McManus, professor of primary care research1,
  2. Mark Caulfield, professor of clinical pharmacology2,
  3. Bryan Williams, professor of medicine3
  1. 1Department of Primary Care Health Sciences, NIHR English School for Primary Care Research, University of Oxford, Oxford OX1 2ET, UK
  2. 2William Harvey Research Institute, Barts and The London School of Medicine and Dentistry and NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London EC1M 6BQ, UK
  3. 3Department of Cardiovascular Sciences, University of Leicester and Leicester NIHR Biomedical Research Unit in Cardiovascular Diseases, Glenfield Hospital, Leicester, LE3 9QP, UK
  1. Correspondence to: R J McManus richard.mcmanus{at}

Richard McManus, Mark Caulfield, Bryan Williams respond to criticisms of the 2011 NICE guideline, arguing that it reflects the reduced costs of generic drugs and new evidence on cardiovascular risk reduction

The two articles criticising some of the recommendations in the recent National Institute for Health and Clinical Excellence (NICE) hypertension guidelines1 2 come from different, and sometimes contradictory, standpoints.3 4 We discuss the process undertaken in developing the recommendations and respond to the points raised.

NICE guideline development process

NICE guidelines are developed through a standardised, rigorous, and transparent method. It starts with the development of a series of questions (the “scope” of the guideline) and setting up a guideline development group with representatives from key stakeholders (typically patient and carer representatives, experts, nurses, general practitioners and a chair or clinical lead, all of whom are appointed after public advertisement), a project manager, and a technical team, with representatives from NICE and other experts sitting in as necessary. There is then a detailed search for efficacy and cost effectiveness literature; where required, technical staff do new meta-analyses and economic modelling.5 The process is open with minutes of all group meetings freely available ( for Hypertension), and there is an extensive and exhaustive process of external consultation for each guideline. This includes detailed consideration of the scope and publication of a draft guideline before the guideline emerges in its final form.5 All responses to the consultation are collated and responded to individually, and an audit process ensures that difficult questions are not ignored. Groups such as specialist societies, commercial organisations, research groups with a particular interest, and hospital trusts can register as stakeholders and provide detailed comments.

In the case of hypertension, the update was partial, which meant that the scope was limited to areas where it was …

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