Management guidelines for hypertension: is anyone taking notice?

A number of national bodies and the World Health Organisation/International Society of Hypertension have published guidelines on the treatment of hypertension, and there is reasonable consensus between them. Repeated and accurate BP measurements are an essential starting point in the clinical management of hypertension. In mild-to-moderate hypertension, non-pharmacological treatments should always be instituted and their impact evaluated before drugs are considered. The recommended diastolic threshold for initiation of drug therapy varies between 90 and 100 mmHg and the systolic threshold lies between 140 and 160 mmHg. There is also agreement that this threshold should be reduced to 140/90 mmHg when multiple risk factors co-exist. The generally accepted aim of treatment is to reduce DBP to < 90 mmHg, but there is controversy about lowering it further to < 80 mmHg. There is convincing evidence that elderly patients benefit most from treatment. It is also clear that treated patients with inadequately controlled BP remain at high risk of premature cardiovascular death. This highlights the need for guidelines that are suitable for routine use in clinical practice.