By Lilian Anekwe
Tough new NICE guidance is set to press GPs to use combinations of drugs to treat hypertension, after a leading adviser criticised their ‘inertia' in switching patients to intensive treatments.
NICE and the British Hypertension Society are set to look at much earlier use of combination therapies, and increasing use of fixed-dose combinations, in a joint review of the 2006 guidance on the management of hypertension.
Pulse revealed earlier this year that the forthcoming JBS3 guidelines would be looking at increasing use of combinations, and it now appears similar NICE recommendations will be developed in tandem, with a draft due out in February. The development follows findings from the ACCELERATE trial presented this week at Hypertension 2010 in Vancouver, demonstrating initial combination therapy could be used safely.
Professor Peter Sever, professor of clinical pharmacology at Imperial College London and a member of the BHS guidelines working party, said the joint guidance would look to strongly ramp up hypertension management.
‘There's still appalling levels of blood-pressure control. Combinations would address compliance, particularly if given in the same pill.'
‘GPs are relatively inert in changing treatments. The ACD algorithm is going to be to the forefront in the [guidance], but with the possible exception of combinations being introduced earlier as initial treatments, instead of a sequential approach.'
Researchers led by several members of the BHS guidelines working party randomised 1,250 patients to aliskiren 150mg and amlodipine 5mg, either in combination or alone, and found mean blood pressure fell over 24 weeks by 6.4mmHg systolic and 3.7mmHg diastolic more in patients on combinations than sequential therapies.
Study leader Professor Morris Brown, professor of clinical pharmacology at the University of Cambridge, said: ‘In patients with systolic blood pressure greater than 150mmHg, there appears little downside to initiating treatment with combinations.'Calcium-channel blockers could be used much earlier