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GPs get disability discrimination alert

NICE guidance on hypertension has come under fire for failing the needs of younger patients.

Patients under the age of 55 should be treated according to the British Hypertension Society's AB/CD guidance and not initiated with a diuretic as NICE suggests, a new study concludes.

And it has emerged that NICE omitted 'quite compelling' data on secondary endpoints relating particularly to the treatment of younger patients because of difficulty interpreting the evidence.

The new research found 45 per cent of patients treated using the AB/CD algorithm hit the target blood pressure of 130/80mmHg but only 17 per cent of those initiated on a diuretic.

Dr Ian Wilkinson, study leader and honorary consultant in clinical pharmacology at Addenbrooke's Hospital, Cambridge, said: 'This study shows young patients respond better to an ACE inhibitor or a ?-blocker, so if you are going to get people to target on the fewest possible drugs, you start them on an A or a B.

'This is providing evidence in real patients and it is a proper comparison of two different strategies. If I was 30 or

40 with hypertension I would want to be on the fewest

drugs that gave me the best

result.'

The study randomly initiated 47 patients under the age of 55 with an ACE inhibitor, ?-blocker, calcium channel blocker or diuretic and cycled them through the four drug types.

Professor Bryan Williams, professor of medicine at the University of Leicester and a member of the guidelines committee, admitted 'quite compelling' evidence from studies such as the LIFE trial had not been included when compiling the NICE guidance.

He stressed NICE had not ignored the evidence, which related to secondary endpoints such as the onset of diabetes and atrial fibrillation, but said 'at present we do not know how to assess its significance'.

Dr John Pittard, a GP in Staines, Middlesex, and a member of the national service framework for CHD external reference group, said secondary endpoints were important to look at as they could help younger patients.

'I think NICE has missed the point, especially with regards to reducing things like diabetes and cardiovascular disease risk.'

By Rob Finch and Brian Kelly

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