This article summarises the new British Hypertension Society guidelines for management of hypertension, which have been published in full.1 Since the previous guidelines2,3 much new evidence has emerged on optimal blood pressure targets4; management of hypertension in diabetic patients4–7; treatment of isolated systolic hypertension8; comparison of the antihypertensive efficacy and tolerability of different drug classes9–11; the role of non-pharmacological measures for prevention12,13 and treatment of hypertension14; and additional benefits associated with the use of aspirin and statins.
Of concern is that national surveys continue to reveal incomplete detection, treatment, and control of hypertension.15 Furthermore, treated hypertensive patients still die prematurely from cardiovascular disease.16 These guidelines aim to present the best currently available evidence on hypertension management and their implementation.
- Use non-pharmacological measures in all hypertensive and borderline hypertensive people
- Initiate antihypertensive drug treatment in people with sustained systolic blood pressure 160 mm Hg or sustained diastolic blood pressure 100 mm Hg
- Decide on treatment in people with sustained systolic blood pressure between 140 and 159 mm Hg or sustained diastolic blood pressure between 90 and 99 mm Hg according to the presence or absence of target organ damage, cardiovascular disease, diabetes, or a 10 year coronary heart disease risk 15% according to the Joint British Societies coronary heart disease risk assessment programme or risk chart
- Optimal blood pressure treatment targets are systolic blood pressure <140 mm Hg and diastolic blood pressure <85 mm Hg; the minimum acceptable level of control (audit standard) recommended is <150/<90 mm Hg
- In the absence of contraindications or compelling indications for other antihypertensive agents, low dose thiazide diuretics or β blockers are preferred as first line treatment for the majority of hypertensive people; compelling indications and contraindications for all antihypertensive drug classes are specified
- Other drugs that reduce cardiovascular risk must also be considered; these include aspirin and statins