Primary Care Pharmacy November 1999 Vol 1 No 1 p32

Journal Club

Hypertension guidelines

Lawrence ER, Williams, B, Johnston GD et al. British Hypertension Society guidelines for hypertension management 1999: summary. BMJ 1999;319:630-5.
[Medline reference]

This article provides a summary of the British Hypertension Society guideline originally published in the Journal of Human Hypertension (J Hum Hypertens 1999;13:569-92).
There are three main differences in approach from the previous BHS guideline:

• Treatment recommendations are based on randomised clinical trials that assess major disease end points rather than simply on reducing blood pressure.
• Treatment initiation is based on the the level of cardiovascular risk rather than the level of blood pressure in the range 140-59/90-99.
• Special indications and contraindictions for specific antihypertensive agents are included, but these are based on consensus rather than evidence, and conflict with guidelines for other cardiovascular diseases which may co-exist in hypertensive patients.

This guideline has important implications for patients and clinical governance in primary care. The authors realise implementation will depend on the efforts of doctors and nurses in general practice, and suggest practices or primary care groups develop a protocol covering screening, evaluation, estimation of cardiac risk, treatment targets, non-pharmacological measures, drug therapy, recall and follow up of patients. Written information for patients and details of which health care professional is responsible for each aspect of management is advised and audit should be carried out on a regular basis.

What's in the medical press? - The rapidly changing situation in primary care means that it is often difficult to keep up to date with what is happening politically and clinically. This section of Primary Care Pharmacy will try to pick out a few articles that may be useful in day-to-day practice or have importance for the primary care role.