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NICE and the British Hypertension Society plan a high-level meeting to thrash out their differences and formulate a unified set of hypertension guidelines, Pulse can reveal.

Moves to resolve the long-running dispute between the organisations have come to a head after this week's long-awaited release of results from the ASCOT trial, throwing the use of betablockers for hypertension into serious doubt.

The confidential meeting, which will not be held until ASCOT results are published in The Lancet in September, will consider whether to remove betablockers from the new guidance – a possibility first raised by Pulse last year.

ASCOT found an ACE inhibitor plus calcium channel blocker could cut all-cause mortality by 15 per cent compared with a diuretic and betablocker.

The combination also cut coronary events by 15 per cent and stroke by 25 per cent, according to the preliminary results, unveiled at the American College of Cardiology meeting in Orlando.

The results have thrown current hypertension guidance into turmoil and cast serious doubt on NICE guidance in particular, since it recommends diuretics first-line with betablockers as first addition.

ASCOT leader Professor Peter Sever, member of the BHS guidelines committee, said: 'My understanding is that there will be a joint statement [by BHS and NICE] and a web cast by the BHS.'

Professor Neil Poulter, president of the BHS, said: 'What will be helpful is if BHS and NICE can sit down and write joint guidelines.'

Professor Bryan Williams, a member of both organisations' guidelines committees, is understood to be 'brokering' the meeting. Professor Williams, professor of medicine at the University of Leicester, confirmed discussions were taking place, although he said they were at a preliminary stage and confidential.

He said: 'When this study reports its data in September we will look at it in the context of all other data and decide whether revision is appropriate. It would be nice to get to a position where we have a single authoritative guideline for the management of high blood pressure.

'Discussions along those lines are proceeding.'

The BHS currently recommends the ABCD formula which takes account of age and ethnicity but NICE claims there is no evidence this is cost-effective.

Dr Terry McCormack, deputy chair of the Primary Care Cardiovascular Society and a GP in Whitby, said: 'Now with ASCOT they are both going to have to go back and look at the guidance, particularly NICE.

'It would help if they didn't come up with two different guidelines because it causes absolute confusion.'

How ASCOT set

changes in


guidance in motion

The study compared atenolol/thiazide with perindopril/ amlodipine in 19,000 hypertensive patients. It recorded:

•15 per cent drop in all-cause mortality

•25 per cent drop in cardiovascular mortality

•25 per cent reduction in stroke

•15 per cent reduction in coronary events

•30 per cent drop in new-onset diabetes

By Nerys Hairon

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