NICE: draft updated hypertension guidelines

  • National Institute for Health and Care Excellence

  • curated by Dawn O'Shea
  • UK Medical News
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Updated draft guidelines from NICE recommend offering antihypertensive medication to people aged

Key treatment recommendations in the draft guidance include:

Step 1

  • Angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) for adults with type 2 diabetes (T2D) or aged
  • Calcium-channel blocker (CCB) for adults aged ≥55 years or those of African/Caribbean origin without T2D.
  • Do not combine ACE-I with ARB.
  • If CCB is not tolerated, offer thiazide-like diuretic.
  • If there is evidence of heart failure, offer a thiazide-like diuretic and follow NICE guideline on chronic heart failure.
  • If starting or changing diuretic, thiazide‑like diuretic is preferred to conventional thiazide diuretic.

Step 2

  • If uncontrolled on step 1 ACE-I or ARB, offer a CCB or thiazide-like diuretic.
  • If uncontrolled on step 1 CCB, offer ACE-I, ARB or thiazide-like diuretic.
  • If uncontrolled in adults of African and Caribbean origin without T2D taking step 1, consider adding ARB in preference to ACE-I.

Step 3 

  • If hypertension is not controlled with step 2 treatment, offer a combination of ACE-I or ARB, and CCB and thiazide-like diuretic.

Step 4 

  • For confirmed resistant hypertension, consider adding a fourth antihypertensive drug or seeking expert advice.
  • Add low-dose spironolactone for adults with blood potassium level of ≤4.5 mmol/L.
  • Use caution in people with reduced estimated glomerular filtration rate.
  • Monitor blood sodium and potassium and renal function within 1 month of starting additional diuretic treatment and repeat as needed.
  • Consider alpha-blocker or beta-blocker for adults with a blood potassium level >4.5 mmol/l.
  • If blood pressure remains uncontrolled with the optimal tolerated doses of 4 drugs, seek expert advice.

The draft guidelines are open for consultation until 23 April 2019.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.