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Longing for clinical excellence: a critical outlook into the NICE recommendations on hypertension management--is nice

Alberto Zanchetti, Giuseppe Mancia

    Journal of Hypertension
    |March 6, 2012
    PubMed

    Insights

    The European guidelines for managing arterial hypertension are being updated, examining UK NICE guidelines for clarity on evidence versus opinion. Key changes in NICE guidelines involve ambulatory blood pressure diagnosis and antihypertensive drug choices.

    Area of Science:

    • Cardiology
    • Hypertension Management

    Background:

    • The European Society of Hypertension and European Society of Cardiology are preparing the 3rd edition of joint guidelines for arterial hypertension management.
    • The authors reviewed the UK NICE guidelines for insights into evidence-based recommendation development.

    Discussion:

    • NICE guidelines show significant changes in diagnosing hypertension using ambulatory blood pressure monitoring.
    • Treatment recommendations now favor specific agents like chlorthalidone and indapamide over less frequent diuretic use.

    Key Insights:

    • NICE's updated recommendations on ambulatory blood pressure and initial antihypertensive choices appear more opinion-based than evidence-driven.
    • Balancing the pursuit of evidence with clinical judgment is crucial, but an overly rigid approach may not always be optimal.

    Outlook:

    • Future hypertension guidelines should carefully distinguish between robust evidence and expert opinion.
    • Further research may be needed to clarify the optimal use of ambulatory blood pressure and specific antihypertensive agents.

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