Intended for healthcare professionals

Rapid response to:

Practice Guidelines

Management of hypertension: summary of NICE guidance

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4891 (Published 25 August 2011) Cite this as: BMJ 2011;343:d4891

Rapid Response:

Antihypertensive therapy in women of child bearing potential

We agree with Kate Harding and Andrew Shennan that when considering
the treatment of hypertension, it is important to emphasise that special
consideration should be given to prescribing of antihypertensive therapy
in women of child bearing potential.

Specific recommendations with this aim were included in the recently
published full NICE guidance on the management of primary hypertension in
adults(NICE clinical guideline 127) and the accompanying quick reference
guide. These state; "Offer antihypertensive drug treatment to women of
child-bearing potential in line with the recommendations on Management of
pregnancy with chronic hypertension and Breastfeeding in 'Hypertension in
pregnancy' (NICE clinical guideline 107). The guidance goes on to
recommend; "Tell women who take angiotensin-converting enzyme (ACE)
inhibitors or angiotensin II receptor blockers (ARBs) that there is an
increased risk of congenital abnormalities if these drugs are taken during
pregnancy and to discuss other antihypertensive treatment with the
healthcare professional responsible for managing their hypertension, if
they are planning pregnancy." Followed by the recommendation to "Stop
antihypertensive treatment in women taking ACE inhibitors or ARBs if they
become pregnant (preferably within 2 working days of notification of
pregnancy) and offer alternatives" and to "to discuss other
antihypertensive treatment with the healthcare professional responsible
for managing their hypertension, if they are planning pregnancy".

These important sections were omitted in the brief version of the
NICE hypertension guideline summary published in the BMJ and we thank the
authors for drawing this to our attention. Fortunately, this important
guidance is included in all of the NICE guideline outputs.

Competing interests: As declared in the original BMJ article on NICE guidance

19 September 2011
Bryan Williams
Professor of Medicine
Taryn Krause, Kate Lovibond, Mark Caulfield, Terry McCormack, on behalf of the guideline development group
NICE Hypertension Guideline Development Group