The National Prescribing Centre has published MeReC Extra 51 (PDF) which discusses the recently updated guidance on the management of hypertension published by NICE.
This MeReC notes that important changes since the previous guidance include:
- Using ambulatory or home blood pressure monitoring to confirm the diagnosis of hypertension
- Offering treatment with a calcium-channel blockers as first choice step 1 antihypertensive for people aged over 55 years and black people of African or Caribbean family origin of any age
- Offering an ACE inhibitor or a low-cost angiotensin-II receptor antagonist (A2RA) as step 1 antihypertensive drug for non-black people younger than 55 years
- Offering an ACE inhibitor or low-cost A2RA in combination with a calcium-channel blocker for people of any age if this is necessary to achieve suitable blood pressure reduction (step 2 drug treatment)
- Offering chlortalidone or indapamide in preference to bendroflumethiazide or hydrochlorothiazide if diuretic therapy is to be changed or initiated
- Offering spironolactone 25 mg once daily as first choice additional treatment (if the person’s blood potassium level is 4.5 mmol/L or less) at step 4
Action: Clinicians who diagnose and treat hypertension will find this to be a useful and informative summary of the key changes to hypertension guideline.