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Pressure from drug firms risks 'collapse of the NHS'

NICE is set to retreat from full-scale conflict with the British Hypertension Society with a partial climbdown over its blood pressure guidance, Pulse has learned.

The final guidelines, due out this Wednesday, are expected to accept that GPs can take into account patients' age in choosing which drug to prescribe first-line, but not their ethnicity.

But the guidance will offer GPs who want to follow the society's ABCD formula an opt-out clause, by allowing them flexibility in tailoring drugs to patients.

NICE told Pulse the guidance would be 'the standard for the NHS' and that it expected its recommendations to 'underpin' future versions of the quality and outcomes framework.

Pulse understands the final guidance will continue to advise that GPs use a thiazide diuretic first-line or, if contraindicated or not tolerated, a ß-blocker. But it will also recommend ß-blockers in patients under the age of 55 – a key concession to the ABCD algorithm promoted by the society.

In an attempt to pour oil on the stormy waters, NICE told Pulse that any remaining differences between the guidelines would 'not be a big deal for GPs'.

Professor Peter Littlejohns, the institute's clinical director, said the conflict around the draft guidelines had helped to ensure the final guidance was as good as possible.

Professor Neil Poulter, pre-sident of the British Hypertension Society, said: 'I'm not sure it's good to have several different guidelines.' But he added that much of what NICE had done was now compatible with the society.

But Dr Terry McCormack, deputy-chair of the Primary Care Cardiovascular Society and a GP in Whitby, said: 'It sounds like an improvement, but at the end of the day I'll follow the ABCD method.'

He added: 'It's a frightening thought that people could only follow Government-backed guidelines. That would be a bit draconian.'

Expected recommendations in the final guidance

•Offer treatment for patients with blood pressure =160/100mmHg or >140/90mmHg and CVD 10-year risk of 20 per cent or more

•Treat to 140/90mmHg target

•Offer thiazide diuretic first-line, or

b-blocker if contraindicated, not tolerated, or the patient is under

55 years old

•If targets are not met, add in a

b-blocker, or ACE inhibitor/ angiotensin receptor blocker if at high risk of diabetes

•Add in calcium channel blocker

if needed

•Add in another drug or consider referral

By Rob Finch

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