The new NICE Guidelines on the treatment of Hypertension

Abstract

In 2011, American and British guidelines on the management of hypertension are scheduled to be updated. The British guidelines, developed by the National Institute for Clinical Excellence, have just been published in August 2011. There are several significant changes in these guidelines. Ambulatory blood pressure is named the new gold standard in the diagnosis of hypertension. It is valuable not only in people with white coat hypertension, but also in people whose ambulatory blood pressures are higher than blood pressure readings in the clinic. Home blood pressure monitoring is now recognised as being useful and informative. Largely as a result of the ASCOT study, calcium channel blockers (CCB) and blockers of the renin-angiotensin system have surpassed diuretics and beta-blockers as first line drugs. Patients 55 or younger should receive an ACE inhibitor, or an angiotensin receptor blocker if the former is not tolerated. Older patients are started on a CCB. A thiazide diuretic is used as the third drug, but interestingly, chorthalidone and indapamide are preferred as they showed favourable outcomes in large clinical trials. Treatment with these three drug classes should be sufficient in the majority of patients, but if triple therapy is insufficient, referral to a hypertension specialist is recommended. Alpha and beta blockers do not even make fourth place, which is taken up by spironolactone. While the new UK guidelines are controversial, the changes are based on the best available current evidence. In Hong Kong, the prevalence of hypertension has been increasing among young and middle-aged men, and is approaching 50% among the elderly. Current efforts are channelled towards the detection and treatment of hypertension in middle and old age. The linear rise in the prevalence of hypertension with age means that measures to prevent hypertension, such as a healthy diet and regular physical activity, should start early in life.