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A row has broken out after the British Hypertension Society allowed the wording of its ABCD rules to be altered by a drug company that agreed to fund dissemination of the guidance to 20,000 GPs.

Merck Sharpe & Dohme received permission from the society to switch the order of the drug classes listed in the 'A' key to the ABCD rules.

The rules, published in the BMJ last year and posted on the society's website, list the choice of 'A' drugs as 'ACE inhibitor or an angiotensin 2 antagonist'. The guidance also advises GPs to use 'the least expensive drugs'.

However, when MSD agreed to a request from the BHS to fund printing and distribution of the guidelines, the company ­ which manufactures the A2A losartan ­ asked for the 'A' key to be switched to read 'angiotensin 2 antagonist or ACE inhibitor'.

Dr Des Spence, a Glasgow GP who spotted the switch, this week reported MSD to the ABPI's code of practice authority. He said there was a 'clear conflict of interest', adding: 'This fatally undermines the credibility of the BHS.'

BHS chair Professor Neil Poulter said he stood by the original guidelines and added: 'It is an error. We certainly would not have agreed to any change from the original.'

But MSD produced e-mail evidence to Pulse showing the new wording had been approved by the society's information service. It said: 'Approval was granted as the BHS information service considered the two classes of drug to be equal in the absence of compelling indications.'

Dr Stewart Findlay, a GP in Bishop Auckland and member of the Primary Care Cardiovascular Society, said: 'I would be very disappointed in the BHS to allow guidance to be influenced by the company.'

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