British Hypertension Society Guidelines for the Management of Hypertension 2000: Brief Summary
RECOMENDATIQNS: SUMMARY POINTS
• Use non-pharmacological measures in all hypertensive and borderline hypertensive people.
• The thresholds for intervention with drug therapy are shown in the figure. NB: A threshold of 160/100 means a systolic BP of
> 160 mmHg or a diastolic BP of > lOO mmHg.
• Optimal BP treatment targets are shown in Table 2: NB: A target of 140/85 mmHg means a systolic of <l4OmmHg and diastolic of <85 mmHg.
• In the absence of contraindications or compelling indications for other antihypertensive agents, low dose thiazide diuretics or b-blockers are preferred as first line treatment for the majority of hypertensive people. Compelling indications and
contraindications for all antihypertensive drug classes are specified in Table 1.
• Other drugs that reduce cardiovascular risk such as aspirin and statins, should be used in those hypertensive patients where additional benefit has been shown.
These recommendations take account of the best available evidence to provide pragmatic advice on thetreatment of hypertension. The evidence supporting these recommendations and advice on the management of hypertension in specific subgroups ie the elderly, diabetes mellitus, renal disease, women, and various ethnicgroups is contained in the full document (refs 1 and 2). The principal objectives of these guidelines are to promote the primary prevention of hypertension and cardiovascular disease and to increase awareness, detection, treatment rates, and blood pressure (BP) control among people with hypertension.
PHARMACOLOGICAL INTERVENTION
Choice of antihypertensive drug.
Since publication of the previous guidelines (4.5), three long term double-blind studies have compared the major classes of antihypertensive drugs (thiazide, b-blocker, calcium antagonist, angiotensin converting enzyme inhibitor, and a-blocker) and overall showed no consistent or important differences as regards antihypertensive efficacy, side-effects, or quality of life. However differences in average response between drug classes are related to age and ethnic group.In general, the elderly and blacks do not respond well to monotherapy with ACE inhibitors or betablockers. Controlled trials of dihydropyridine calcium antagonists have not supported earlier concerns about the safety of these drugs. Nifedipine in capsule form should no longer be prescribed. When none of the special considerations shown in table 1 apply the least expensive drug, with the most supportive evidence - a low dose of a thiazide diuretic - should be preferred.
table 1
Asthma or COPD, Heart block
table 2
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