{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T10:58:06Z","timestamp":1777892286934,"version":"3.51.4"},"reference-count":35,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2012,9,1]],"date-time":"2012-09-01T00:00:00Z","timestamp":1346457600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of the Royal College of Physicians of Edinburgh"],"published-print":{"date-parts":[[2012,9]]},"abstract":"<jats:p>National Institute for Health and Clinical Excellence guidance for the clinical management of hypertension, published last year, proposes a step change in UK clinical practice.1 Although broadly helpful, there are some concerns about its implementation. Ambulatory blood pressure monitoring for diagnosis of hypertension, though logical, will place an additional financial burden on primary care at a time of austerity. Home blood pressure measurement may be a more practical option. Previous guidance recommended the used of thiazide diuretics as a first-line treatment option.2 Five years later, the new guidelines propose a major change, with an initial emphasis on the use of calcium channel blockers and angiotensin converting enzyme inhibitors\/angiotensin receptor blockers, moving the use of thiazide-like diuretics to a third-line option. In addition, bendroflumethiazide, the mainstay of treatment in the UK over many years, has been replaced with chlortalidone, the starting doses of which are not readily available in this country. Cost-effectiveness analysis and a presumed risk of metabolic disorders has guided the rationale for these changes to the therapeutic algorithm, however this may not be robust. Importantly, unless there are special circumstances, reducing the blood pressure in hypertensive patients is more important than the means used to lower it. In future, it will be important to \u2018personalise\u2019 treatment more effectively and base management on lifetime risk.<\/jats:p>","DOI":"10.4997\/jrcpe.2012.314","type":"journal-article","created":{"date-parts":[[2012,9,5]],"date-time":"2012-09-05T10:39:10Z","timestamp":1346841550000},"page":"251-257","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Observing the NICEties of hypertension management"],"prefix":"10.1177","volume":"42","author":[{"given":"EE","family":"Morrison","sequence":"first","affiliation":[{"name":"Clinical Pharmacology and Therapeutics ST3, Royal Infirmary of Edinburgh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"EJ","family":"Turtle","sequence":"additional","affiliation":[{"name":"McKenzie Lecturer, University of Edinburgh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DJ","family":"Webb","sequence":"additional","affiliation":[{"name":"Professor of Therapeutics and Clinical Pharmacology, University of Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2012,9,1]]},"reference":[{"key":"bibr1-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"1National Institute for Health and Clinical Excellence. Hypertension: the clinical management of primary hypertension in adults. CG127 [Internet]. London: National Clinical Guideline Centre; 2011 [cited 2012 June 17]. Available from: http:\/\/www.nice.org.uk\/nicemedia\/live\/13561\/56007\/56007.pdf","DOI":"10.1016\/j.ycar.2012.02.067"},{"key":"bibr2-JRCPE.2012.314","unstructured":"2National Institute for Health and Clinical Excellence. Hypertension: management of hypertension in adults in primary care. CG34 [Internet]. London: NICE; 2006 [cited 2012 July 26]. Available from: http:\/\/www.nice.org.uk\/nicemedia\/pdf\/CG034NICEguideline.pdf"},{"key":"bibr3-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"3 Kearney PM, Whelton M, Reynolds K  Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365:217\u201323. http:\/\/dx.doi.org\/doi:10.1016\/S0140-6736(05)17741-1","DOI":"10.1016\/S0140-6736(05)70151-3"},{"key":"bibr4-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"4 Lopez AD, Mathers CD, Ezzati M  Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006; 367:1747\u201357. http:\/\/dx.doi.org\/10.1016\/S0140-6736(06)68770-9","DOI":"10.1016\/S0140-6736(06)68770-9"},{"key":"bibr5-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"5 Lewington S, Clarke R, Qizilbash N  Age specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360:1903\u201313. http:\/\/dx.doi.org\/10.1016\/S0140-6736(02)11911-8","DOI":"10.1016\/S0140-6736(02)11911-8"},{"key":"#cr-split#-bibr6-JRCPE.2012.314.1","unstructured":"6 Craig R, Mindell J (editors). Health survey for England 2006. Volume 1: Cardiovascular disease and risk factors in adults [Internet]. Leeds: The Information Centre"},{"key":"#cr-split#-bibr6-JRCPE.2012.314.2","unstructured":"2008 [cited 2012 June 17]. Available from: http:\/\/www.ic.nhs.uk\/webfiles\/publications\/HSE06\/HSE%2006%20report%20VOL%201%20v2.pdf"},{"key":"bibr7-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"7 Luengo-Fern\u00e1ndez R, Leal J, Gray A  Cost of cardiovascular diseases in the United Kingdom. Heart 2006; 92:1384\u20139. http:\/\/dx.doi.org\/10.1136\/hrt.2005.072173","DOI":"10.1136\/hrt.2005.072173"},{"key":"bibr8-JRCPE.2012.314","unstructured":"8National Institute for Health and Clinical Excellence. Lipid modification. CG67 [Internet]. London: The National Collaborating Centre for Primary Care; 2008 [cited 2012 June 17]. Available from: http:\/\/www.nice.org.uk\/nicemedia\/live\/11982\/40742\/40742.pdf"},{"key":"bibr9-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"9 Leenen FH, Nwachuku CE, Black HR  Clinical events in highrisk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial. Hypertension 2006; 48:374\u201384. http:\/\/dx.doi.org\/10.1161\/01.HYP.0000231662.77359.de","DOI":"10.1161\/01.HYP.0000231662.77359.de"},{"key":"bibr10-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"10 Piller LB, Ford CE, Davis BR  Incidence and predictors of angioedema in elderly hypertensive patients at high risk for cardiovascular disease: a report from the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J Clinical Hypertens (Greenwich) 2006; 8:649\u20136. http:\/\/dx.doi.org\/10.1111\/j.1524-6175.2006.05689.x","DOI":"10.1111\/j.1524-6175.2006.05689.x"},{"key":"bibr11-JRCPE.2012.314","unstructured":"11National Institute for Health and Clinical Excellence. Medicine adherence. CH76 [Internet].London: The National Collaborating Centre for Primary Care; 2009 [cited 2012 June 17]. Available from: http:\/\/www.nice.org.uk\/nicemedia\/live\/11766\/42971\/42971.pdf"},{"key":"bibr12-JRCPE.2012.314","unstructured":"12National Institute for Research Excellence. Hypertension: costing report. Implementing NICE guidance. CG127 [Internet]. London: NICE; 2011 [cited 2012 June 17]. Available from: http:\/\/www.nice.org.uk\/nicemedia\/live\/13561\/56016\/56016.pdf"},{"key":"bibr13-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"13 Johnston ME, Gibson ES, Terry CW  Effects of labelling on income, work and social function among hypertensive employees. J Chron Dis 1984; 37:417\u201323. http:\/\/dx.doi.org\/10.1016\/0021-9681(84)90025-0","DOI":"10.1016\/0021-9681(84)90025-0"},{"key":"bibr14-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"14 Gustavsen PH, H\u00f8egholm A, Bang LE  White coat hypertension is a cardiovascular risk factor: a 10-year follow-up study. J Hum Hypertens 2003; 17:811\u20137. http:\/\/dx.doi.org\/10.1038\/sj.jhh.1001643","DOI":"10.1038\/sj.jhh.1001643"},{"key":"bibr15-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"15 Sega R, Facchetti R, Bombelli M  Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Circulation 2005; 111:1777\u201383. http:\/\/dx.doi.org\/10.1161\/01.CIR.0000160923.04524.5B","DOI":"10.1161\/01.CIR.0000160923.04524.5B"},{"key":"bibr16-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"16 Go AS, Hylek EM, Phillips KA  Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285:2370\u20135. http:\/\/dx.doi.org\/10.1001\/jama.285.18.2370","DOI":"10.1001\/jama.285.18.2370"},{"key":"#cr-split#-bibr17-JRCPE.2012.314.1","unstructured":"17ISD Scotland. Prescribing and medicines: prescription cost analysis financial year 2010\/2011 [Internet]. Edinburgh: ISD Scotland"},{"key":"#cr-split#-bibr17-JRCPE.2012.314.2","unstructured":"2012 [cited 2012 June 17]. 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BMJ 1990; 300:975\u20138. http:\/\/dx.doi.org\/10.1136\/bmj.300.6730.975","DOI":"10.1136\/bmj.300.6730.975"},{"key":"bibr21-JRCPE.2012.314","first-page":"51","volume":"18","author":"Neff KM","year":"2010","journal-title":"Hydrochlorothiazide versus chlorthalidone in the management of hypertension"},{"key":"bibr22-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"22 Ernst ME, Carter BL, Goerdt CJ  Comparative antihypertensive effects of hydrochlorothiazide and chlorthalidone on ambulatory and office blood pressure. Hypertension 2006; 47:352\u20138. http:\/\/dx.doi.org\/10.1161\/01.HYP.0000203309.07140.d3","DOI":"10.1161\/01.HYP.0000203309.07140.d3"},{"key":"bibr23-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"23 Dorsch MP, Gillespie BW, Erickson SR  Chlorthalidone reduces cardiovascular events compared with hydrochlorothiazide: a retrospective cohort analysis. Hypertension 2011; 57:689\u201394. http:\/\/dx.doi.org\/10.1161\/HYPERTENSIONAHA.110.161505","DOI":"10.1161\/HYPERTENSIONAHA.110.161505"},{"key":"bibr24-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"24Mortality after 10 1\u20442 years for hypertensive participants in the Multiple Risk Factor Intervention Trial. Circulation 1990; 82:1616\u201328. http:\/\/dx.doi.org\/10.1161\/01.CIR.82.5.1616","DOI":"10.1161\/01.CIR.82.5.1616"},{"key":"bibr25-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"25 Peterzan MA, Hardy R, Chaturvedi N  Meta-analysis of doseresponse relationships for hydrochlorthiazide, chlorthalidone and bendroflumethiazide on blood pressure, serum potassium and urate. Hypertension 2012; 59:1104\u20139. http:\/\/dx.doi.org\/10.1161\/HYPERTENSIONAHA.111.190637","DOI":"10.1161\/HYPERTENSIONAHA.111.190637"},{"key":"bibr26-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"26 Brown MJ, McInnes GT, Papst CC  Aliskiren and the calcium channel blocker amlodipine combination as an initial treatment for hypertension control (ACCELERATE): a randomised, parallel-group trial. Lancet 2011; 377:312\u201320. http:\/\/dx.doi.org\/10.1016\/S0140-6736(10)62003-X","DOI":"10.1016\/S0140-6736(10)62003-X"},{"key":"bibr27-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"27 Wald DS, Law M, Morris JK  Combination therapy vs monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am J Med 2009; 122:290\u2013300. http:\/\/dx.doi.org\/10.1016\/j.amjmed.2008.09.038","DOI":"10.1016\/j.amjmed.2008.09.038"},{"key":"bibr28-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"28 Egan BM, Bandyopadhyay D, Shaftman SR  Initial monotherapy and combination therapy and hypertension control the first year. Hypertension 2012; 59:1124\u201331. http:\/\/dx.doi.org\/10.1161\/HYPERTENSIONAHA.112.194167","DOI":"10.1161\/HYPERTENSIONAHA.112.194167"},{"key":"bibr29-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"29 Bejan-Angoulvant T, Saadatian-Elahi M, Wright JM  Treatment of hypertension in patients 80 years and older: the lower the better? A meta-analysis of randomized controlled trials. J Hypertens 2010; 28:1366\u201372. http:\/\/dx.doi.org\/10.1097\/HJH.0b013e328339f9c5","DOI":"10.1097\/HJH.0b013e328339f9c5"},{"key":"bibr30-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"30 Beckett NS, Peters R, Fletcher AE  Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358:1887\u201398. http:\/\/dx.doi.org\/10.1056\/NEJMoa0801369","DOI":"10.1056\/NEJMoa0801369"},{"key":"bibr31-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"31 Chang-Quan H, Hui W, Chao-Min W  The association of antihypertensive medication use with risk of cognitive decline and dementia: a meta-analysis of longitudinal studies. Int J Clin Pract 2011; 65:1295\u20131305. http:\/\/dx.doi.org\/10.1111\/j.1742-1241.2011.02810.x","DOI":"10.1111\/j.1742-1241.2011.02810.x"},{"key":"bibr32-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"32 Sundstr\u00f6m J, Neovius M, Tynelius P  Association of blood pressure in late adolescence with subsequent mortality: cohort study of Swedish male conscripts. BMJ 2011; 342:d643. http:\/\/dx.doi.org\/10.1136\/bmj.d643","DOI":"10.1136\/bmj.d643"},{"key":"bibr33-JRCPE.2012.314","doi-asserted-by":"crossref","unstructured":"33 Serumaga B, Ross-Degnan D, Avery AJ  Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study. 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