Late last year the new American Hypertension Guidelines 2017 managed to supplant the NICE lipid guideline of 2014 with the dubious honour of being the most controversial guideline ever published. They re-defined hypertension, set ambitious treatment targets and created a huge debate around their potential for overdiagnosis and overtreatment.
This month has seen the publication of new European Hypertension Guidelines 2018 produced by the European Societies of Hypertension and Cardiology. These guidelines have some key differences but are broadly similar to the American ones and propose significant changes in practice. We have read the guideline (all 98 pages of it!) and bearing in mind the ‘guidelines not tramlines’ mantra these are our Top 5 learning points:
Doubtless these guidelines will prove as controversial as the American ones. But we GPs know that guidelines should be individually applied according to clinical judgement and patient choice, and that for hypertension lifestyle change comes first and people at higher absolute risk should be our treatment priority. As a recent BMJ editorial pointed out all the debate and controversy over thresholds and targets should not distract from the main issue of under treatment of people already at high risk. A greater use of out of office measurement, a first target of getting all patients under 140/90 and offering patients the option of quicker better control with combinations of drugs seem a start along this road.
If you find these clinical summaries helpful you will love our Hot Topics course. Click here for information about face-to-face events and online courses.
This blog was originally published via the Hot Topics Blog, NB Medical on 4th October 2018.
Simon is the Medical Director NB Medical Education, an NHS GP in Oxford and Hon Senior Clinical Lecturer in General Practice, Oxford University.
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