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An influential NHS-funded review has given GPs the green light to ignore controversial NICE guidelines that aim to restrict their choice of first-line antihypertensive.

In an Effective Health Care Bulletin published last week, the Centre for Reviews and Dissemination has concluded that GPs selecting antihypertensives for black patients are 'justified' in following the ABCD rules endorsed by the British Hypertension Society but maligned by NICE.

Under the ABCD approach, a calcium channel blocker or diuretic is the first-line choice in all black patients.

The new bulletin ­ which will be distributed free to 60,000 NHS decision-makers ­ concludes hypertension in black patients is more likely to be controlled by calcium channel blockers and diuretics than by ACE-inhibitors or ?-blockers ­ both of which were no more effective than placebo.

It also warns that the evidence suggests ?-blockers may actually increase systolic blood pressure in black patients.

NICE caused uproar when its hypertension guidance claimed there was 'no justification' for the ABCD rules, which also recommend an ACE inhibitor, A2A blocker or ?-blocker first-line in non-black patients under the age of 55. NICE claimed the rules had been drawn up 'without reference to cost'.

It urged GPs to use diuretics or ?-blockers first-line in all patients.

Dr Mark Davies, a GP in Leeds and a member of the committee that wrote the national service framework for CHD, said: 'NICE just looked at essential hypertension. The BHS also looked at hypertension in people with co-morbidities such as diabetes ­ the people GPs are likely to see. The ABCD is pragmatic and should be supported by GPs.'

Dr Peter Randall, CHD lead for Isle of Wight PCT, said he would treat black patients using the ABCD approach but most GPs would follow NICE. 'NICE is equivalent to a Government direction ­ we have to follow NICE or be able to justify not doing so.'

Professor Neil Poulter, president of the BHS, said he had been 'amazed' that NICE rejected ABCD. He urged GPs to follow the rules in elderly as well as black patients.

'The VALVE trial supported the CD approach in the elderly ­ how much more evidence do we need?'

By Rob Finch

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