UK hypertension guidelines updated
Blood pressure target for most patients remains at 140/85mmHg or
lower |
Blood pressure guidelines, updated by the British Hypertension Society (BHS), now include a treatment algorithm to aid more logical use of antihypertensive drugs, alone and in combination (summarised in the
BMJ 2004;328:634).
The 1999 version of the guidelines advised starting patients on the least
expensive drug, usually a thiazide diuretic. But the 2004 guidelines
recommend that treatment for white and younger hypertensive patients
(under 55 years) should start with an angiotensin converting enzyme (ACE)
inhibitor, angiotensin receptor blocker or beta blocker, while treatment
for black and older hypertensive patients (over 55 years) should start
with a calcium channel blocker or a diuretic.
Indications and contraindications for treatment remain similar to the
1999 guidance, although more hypertensive patients with early signs of
renal disease or heart failure are likely to be prescribed ACE inhibitors
or angiotensin receptor blockers than before.
The BHS continues to stress that most hypertensive patients will require
more than one drug to control their blood pressure. It recommends combining
drugs which inhibit the renin-angiotensin system with those that do not.
The target blood pressure for most patients remains 140/85mmHg or lower
(minimum target <150/90mmHg), with a target of 130/80mmHg or lower
for those with diabetes, renal impairment or established cardiovascular
disease.
The BHS predicts an extended role for pharmacists, nurse practitioners
and other health care professionals in detecting, monitoring and treating
high blood pressure and cardiovascular risk, if blood pressure control
is to be improved in the UK.
Recent research has estimated that 42 per cent of people aged 35–64
years in the UK have blood pressure over 140/90mmHg (JAMA 2003;289:2363)
and good control is achieved in only 10 per cent of the hypertensive
population (Hypertension 2004;43:10). |
The
Pharmaceutical Journal