The British Medical Journal has featured 3 “Analysis” articles in which the authors discuss the 2011 NICE clinical guidelines on the management of hypertension. One article, written by members of the NICE hypertension guideline development group supports the guideline by describing the evidence and considerations that had been used to draw up the guideline. The other 2 articles argue that the guidelines need updating both in light of evidence to suggest that all classes of blood pressure lowering drugs are broadly equivalent, and certain assumptions in the guideline that are based on insufficient evidence.

The authors of one of the articles that suggest that the guideline needs updating, state that the following statements in the clinical guideline are considered as needing further evidence:

• That hypertension is overtreated

• That hypertension should be redefined by daytime ambulatory blood pressure monitoring

• That daytime average systolic blood pressure <150 mmHg should not be treated, irrespective of clinic or other peak pressures, unless annual risk of cardiovascular morbidity exceeds 2%

• That people with daytime average systolic blood pressure <135 mm Hg should not receive drug treatment but be rechecked by ambulatory monitoring every five years

• Diuretics are less effective than calcium channel blockers at reducing blood pressure variability and should therefore be third choice treatment

• Chlortalidone and indapamide are superior to bendroflumethiazide and hydrochlorothiazide

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