The National Institute for Health and Clinical Excellence (NICE) has issued an updated clinical guideline on the diagnosis and management of hypertension (CG 127).

The recommendations that have been reviewed in this partial update of the guideline for the clinical management of primary hypertension in adults, include; blood pressure measurement for the diagnosis of hypertension; blood pressure thresholds for intervention with drug therapy and blood pressure targets for treatment; specific aspects of the recommendations for the pharmacological treatment of hypertension; the treatment of hypertension in the very elderly (people aged greater than 80 years); dilemmas surrounding decision making for treatment of hypertension in younger adults (less than 40 years); the treatment of drug resistant hypertension; and wherever appropriate, the impact of age and ethnicity on treatment recommendations.

The following recommendations are new in the updated guideline:

• With respect to the diagnosis of hypertension, if the clinic blood pressure is 140/90 mmHg or higher, offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension. Use the average value of at least 14 measurements taken during the person’s usual waking hours to confirm a diagnosis of hypertension.

• With respect to initiating treatment for hypertension, the guideline states that an antihypertensive should be offered to patients under 80 years who have one or more of the following risk factors:  target organ damage, established cardiovascular disease, renal disease, diabetes, and a 10-year cardiovascular risk equivalent to 20% or greater (new). Additionally, an antihypertensive should be initiated for people of any age, with stage 2  hypertension (new). For people aged under 40 years with stage 1 hypertension and no evidence of target organ damage, cardiovascular disease, renal disease or diabetes, consider seeking specialist evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage. This is because 10-year cardiovascular risk assessments can underestimate the lifetime risk of cardiovascular events in these people.

With respect to choosing treatments, the following new recommendations have been made:

• Offer people aged 80 years and over the same antihypertensive drug treatment as people aged 55–80 years, taking into account any comorbidities.

• Offer step 1 antihypertensive treatment with a calcium-channel blocker (CCB) to people aged over 55 years and to black people of African or Caribbean family origin of any age. If a CCB is not suitable, for example because of oedema or intolerance, or if there is evidence of heart failure or a high risk of heart failure, offer a thiazide-like diuretic.

• If diuretic treatment is to be initiated or changed, offer a thiazide-like diuretic, such as chlortalidone (12.5–25.0 mg once daily) or indapamide (1.5 mg modified-release or 2.5 mg once daily) in preference to a conventional thiazide diuretic such as bendroflumethiazide or hydrochlorothiazide.

• For people who are already having treatment with bendroflumethiazide or hydrochlorothiazide and whose blood pressure is stable and well controlled, continue treatment with the bendroflumethiazide or hydrochlorothiazide.

Please see link below for further details. The Department of Health and BBC Health news have also reported on the updated guidelines.