The new British Hypertension Society guidelines: a view from primary care
These delayed, and much expanded, guidelines for the management of hypertension, represent the third attempt by the British Hypertension Society (BSH) to influence clinical practice. There will be many who feel that the 6-year gap between these guidelines and those based on the Second Working Party in 1993 has been too long. However, one major consequence is the sheer weight of strong clinical evidence that permeates throughout these guidelines, some of which was published quite recently such as important data to guide appropriate targets for blood pressure treatment. The result makes for very compelling reading. Although the guidelines have also been published in summary form in the British Medical Journal, I hope that most doctors will take the time to read the full guidelines published in this journal. However, at over 16 pages of close type-face, it seems likely that few practitioners will avail themselves of this reasonable, and reasonably concise, summary of the best evidence available that has been categorised by the authors. My hope, and recommendation, would be that, at the very least, the clinical governance leads for primary care groups around the country and whoever leads on coronary heart disease within individual practices will indeed read and digest the content of these revised guidelines. They could do a lot worse than use these as the basis for their approach to cardiovascular risk reduction. Not surprisingly, it will become apparent that one major issue for these guidelines is to avoid the viewpoint that hypertension is a disease in isolation. The importance of viewing hypertension alongside, and as part of the reduction of cardiovascular risk, is a major and repeated component. Fortunately, the authors have chosen to advocate for the formal estimation of 10-year coronary heart disease and cardiovascular disease risk using the methods advocated