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- ABPM, ambulatory blood pressure monitoring
- ACEI, angiotensin-converting enzyme inhibitor
- ARB, angiotensin type 1 receptor blocker
- CCB, calcium-channel blocker
- NICE, National Institute for Health and Clinical Excellence
“…practitioners should realise that recommendations can never replace sound clinical judgment or take precedence over the personal interaction between patient and doctor”
The National Institute for Health and Clinical Excellence (NICE)1 and the Joint British Societies2 recently updated their recommendations for the management of hypertension. This short editorial commentary reviews some aspects of these guidelines1,2 against the background of other directives3–6 and identifies some areas of discrepancy that need further reflection. A detailed overview of the literature falls beyond the scope of this commentary, but references supporting our views are available in the guideline documents1,2,4–6 or in our previous publications.7–9
BLOOD PRESSURE MEASUREMENT
The management of hypertension rests on the accurate assessment of blood pressure. Compared to conventional blood pressure measurement, automated techniques of recording, especially ambulatory blood pressure monitoring (ABPM), provide a more precise estimate of a patient’s usual blood pressure, exclude observer bias, minimise the white-coat effect, and refine risk stratification.10 In addition, ABPM gives information on the diurnal blood pressure pattern, the efficacy of 24 h blood pressure control, and the presence of nocturnal hypertension, which carries an adverse prognosis.10
A major difference between the British guidelines1–3 on the one hand and the European6 and US5 directives on the other lies in the use of ABPM in primary care. The original NICE guideline1 states that the appropriate use of ABPM in primary care remains an issue for future research. The guideline of the British Hypertension Society does not recommend the use of ABPM for all patients, but acknowledges its use in specific circumstances.3 On the other hand, the US5 and European6 guidelines clearly accept that ABPM has a definite place in the clinical management of hypertension. Future revisions …
Conflicts of interest: JA Staessen and E O’Brien consulted for pharmaceutical companies and received funding for studies, seminars, and travel from manufacturers of drugs that lower blood pressure.