Many people will be on or have relatives on medication to treat high blood pressure (hypertension) so the news that there is new advice on treating it is not entirely out of place here. It comes from the British “National Institute of Health and Clinical Excellence” (NICE) but its recommendations have implications that you should note.
These have been re-written in the light of research which shows that one older group of drugs commonly used has significant drawbacks for those with simple hypertension including an increased risk of diabetes. Called beta blockers, they have other side effects, including impotence (so if Rush Limbaugh is on em, that could explain the viagra for his little weekend away – well I had to get a US political link somewhere somewhere).
More details below the fold.
NICE is a sort of supercharged version of the FDA. It not only approves drugs for use in National Health Service treatments, it also recommends treatment regimes to doctors. The easiest way to summarise the new recommendations is to quote the BBC report
Two million people in the UK are currently treated with Beta-blockers for hypertension.
The drugs are also used to treat heart failure and angina and should still be used for these problems.
But NICE now says the evidence suggests they perform less well than other drugs in treating high blood pressure, particularly in the elderly, and there is increasing evidence that they carry an “unacceptable risk” of provoking type 2 diabetes.
Instead doctors should use another class of drugs, adding in different ones if a patient’s blood pressure remains high, it says.
Recommendations
Black patients of any age or patients aged over 55 in all other ethnic groupings should be treated with a class of drugs called calcium channel blockers or drugs called diuretics.
If a person’s blood pressure remains too high – the target is 140/90mmHg – they can take a second group of drugs called ACE inhibitors and if they need further treatment the GP can add whichever of the three the person has yet to take.
NEW RECOMMENDATIONS
In patients under 55, first drug should be an ACE inhibitor, followed by a calcium channel blocker or a diuretic, then all three
In patients over 55, or black patients, first choice should be a calcium channel blocker or diuretic, followed by an ACE inhibitor, and then all three if necessary
Beta-blockers should no longer be used for hypertension except in patients who need them for other reasons such as heart failure
The most recent advice from the US National Heart, Lung and Blood Institute’s Joint National Committee (.pdf) published in the Journal of the American Medical Association (JAMA) appears to have been issued in 2003 and still includes the use of beta blockers in the ordinary range of treatment. Handily it lists the drugs in this group commonly used in the USA in table 4 on JAMA page 2565.
The important thing to note is that beta blockers do have uses in treating other associated illnesses like heart failure or angina. You should also continue to take any prescribed ones until you have a review consulation with your doctor. There are guidelines for both patients and doctors on the NICE web site in .pdf and Word formats.
