Two better than one where lowering blood pressure is concerned

A new set of guidelines for lowering blood pressure has been published by the British Hypertension Society (BHS) today. Their main recommendation is that most people with hypertension should be on two blood pressure lowering drugs rather than one.

The guidelines which are aimed at UK doctors, are published in summary form in the BMJ today (12 March), and represent best practice in treating UK patients for hypertension.

People with a blood pressure higher than 140/90 (mm Hg) are classified as having high blood pressure or hypertension.

Some 42 per cent of people in the UK aged between 35 and 64 are estimated to have hypertension, which puts them at a greatly increased risk of heart attacks and strokes.

Basing their guidelines on new data from clinical trials and safety tests of anti-hypertensive drugs, the guidelines say that for the best results in the UK, doctors must aim to get the blood pressure of their patients as low as possible, and for many that means taking a combination of the presently available drugs.

BHS President, Professor Neil Poulter of Imperial College London and St Mary’s hospital, Paddington, and co-author of the BMJ paper said:

“We suggest that two-thirds of people with hypertension should be on two drugs not one to get them down to their target blood pressure.

“But we know that 60 per cent of people on treatment for hypertension are receiving just one blood pressure lowering drug, meaning that many people are missing out on what we consider the best standard of treatment in this country.

The guidelines, authored by the Guidelines Committee of the British Hypertension Society, also suggest a simple ’AB/CD protocol’ to help doctors combine the different classes of blood pressure lowering drugs to provide the best treatment.

For those under 55, they say start with an ACE Inhibitor (or an Angiotensin receptor blocker) or a Beta blocker, and then if the target lower blood pressure is not reached, to use either a Calcium channel inhibitor or a Diruretic in addition, until the target is reached.

For those over 55, they suggest starting with a Calcium channel inhibitor or a Diruretic first, and if the target lower blood pressure is not reached, to use an ACE Inhibitor (or an Angiotensin receptor blocker) or a Beta blocker in addition.

For black patients they recommend using the same protocol as suggested for those over 55, regardless of patient’s age, as the ’C and D’ drugs are more effective on older people and in the black population than ’A and B’ drugs. This is because older people and black people have less natural renin than non-black (white and asian) and younger people, and C and D drugs work better than A and B where renin levels are low.

The BHS guidelines were last revised in 1999. Specialists in the field representing over 12 different stakeholder organisations including the British Hearth Foundation, the Royal College of General Practitioners and the UK Department of Health contributed to the latest guidelines.

For further information, please contact:

Professor Neil Poulter
International Centre for Circulatory Health
Imperial College London and St Mary’s Hospital, London
Tel: 44-207-594-3446
Email: n.poulter@imperial.ac.uk

Tony Stephenson
Imperial College London Press Office
Tel: 44-207-594-6712
Mobile: 44-775-373-9766
E-mail: at.stephenson@imperial.ac.uk