Intended for healthcare professionals

Practice Guidelines

Hypertension in adults: summary of updated NICE guidance

BMJ 2019; 367 doi: (Published 21 October 2019) Cite this as: BMJ 2019;367:l5310
  1. Rebecca J Boffa, senior research fellow1,
  2. Margaret Constanti, senior health economist1,
  3. Christopher N Floyd, clinical adviser2 3,
  4. Anthony S Wierzbicki, chair of guideline committee and consultant in metabolic medicine/chemical pathology4
  5. on behalf of the Guideline Committee
  1. 1National Guideline Centre, London, UK
  2. 2Department of Clinical Pharmacology, King’s College London British Heart Foundation Centre, London, UK
  3. 3Biomedical Research Centre, Clinical Research Facility, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  4. 4Guy’s & St Thomas’ NHS Foundation Trust, London, UK
  1. Correspondence to R Boffa rebecca.boffa{at}

What you need to know

  • Discuss treatment with people with stage 1 hypertension and a 10 year risk for cardiovascular disease ≥10%

  • Choice of antihypertensive drug treatment should take into account patient preferences; a new decision aid has been produced to support this

  • Consistently maintain blood pressure below target, rather than aim for a target

  • Existing blood pressure targets have not been lowered; the benefits and harms of lowering them could not be fully determined from current evidence

  • Asymptomatic, severe hypertension (≥180/120 mmHg) does not require same day specialist review, but investigations for target organ damage should be carried out as soon as possible

  • The guideline now makes recommendations for people with type 2 diabetes

Hypertension is a leading global cause of morbidity and mortality. More than 25% of the adult UK population has hypertension, and in about 30% blood pressure remains uncontrolled.1 In August, the National Institute for Health and Care Excellence (NICE) published its updated guideline on the diagnosis and management of hypertension. The guideline reviews further evidence that has emerged since it was last updated in 2011 from randomised trials investigating the initiation, monitoring, and choice of antihypertensive treatment. The scope of the updated guideline has increased to also include people with type 2 diabetes, but does not make recommendations for people with chronic kidney disease, established cardiovascular disease, or hypertension in pregnancy.

This article summarises the most recent recommendations from NICE and includes information considered to be most relevant to primary care clinicians. Key changes to current practice include offering drug treatment to people at a lower threshold for 10 year risk of cardiovascular disease, emphasis on maintaining blood pressure below target, and clarifying criteria for same day specialist review in people with accelerated hypertension.


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of …

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