Review hypertension management, says NICE
Drug recommendations
The new NICE guideline recommends that drug therapy should be
offered to patients with persistent high blood pressure of 160/100mmHg
or more and to those at raised cardiovascular risk with persistent
blood pressure of more than 140/90mmHg.
It states that a low-dose
thiazide-type diuretic should be used first line, with a beta-blocker
as second line unless the patient has an increased risk of new
onset diabetes, in which case an angiotensin converting enzyme
inhibitor should be added.
A dihydropyridine calcium-channel blocker
is recommended as third line. |
Local health communities are being asked to review their management of hypertension against a new guideline issued this week by the National Institute for Clinical Excellence and the Newcastle Guideline Development and Research Unit.
The priorities for implementation focus on measuring blood pressure,
assessing cardiovascular risk, pharmacological and lifestyle interventions,
and continuing treatment.
Assessment of cardiovascular risk in patients with persistent raised
blood pressure is a key theme and will help identify diabetes, evidence
of hypertensive damage to the heart and kidneys and secondary causes
of hypertension.
The guideline also recommends that lifestyle advice should be offered
initially and then periodically to patients undergoing
treatment for hypertension.
If a patient has well-controlled blood pressure and is at low cardiovascular
risk, the guideline states that they should be offered a trial reduction
or withdrawal of therapy with appropriate lifestyle guidance and review.
Mohammed Ahmed, prescribing pharmacist at Doncaster West Primary Care
Trust, told The Journal: “Supplementary prescribers need to grasp
the guidelines because these are guidelines against which they will be
judged. I will certainly deviate from these on occasions but only when
evidence permits me and in discussion with the independent prescriber.”
Graham MacGregor, chairman of the Blood Pressure Association, voiced
some concerns about the recommendations. “The guidelines assume
a model patient scenario of someone who has hypertension alone, and do
not reflect the range of treatment options which may be more beneficial
to patients presenting with pre-existing conditions.” He pointed
out that the British
Hypertension Society’s guidelines published
earlier this year (PJ, 20 March, p342) differentiate between age and
ethnic groups and provide a range of treatment options. He said: “The
association is concerned that the presence of two guidelines may lead
to confusion both for patients and health care professionals, and particularly
that there are differences in the treatment pathway.”
The new guideline can be accessed here |
The
Pharmaceutical Journal
Acrobat
Reader