The survey of 238 GPs revealed that while 94 per cent had started to use the latest hypertension guidelines, 45 per cent applied them in conjunction with older recommendations, including the Joint British Societies’ guideline (JBS2) and previous BHS guidance.
It also showed that 9 per cent of those using a combination of guidelines referred to local protocols.
RCGP chairman Professor Mayur Lakhani criticised this mix-and-match approach, saying it compromised patient safety.
‘I would be concerned if inadvertent pressure was being put on GPs by primary care organisations (PCOs) to deviate from NICE guidance, which is the gold standard,’ he said. ‘A true translation of the NICE guidance by PCOs for local implementation could be workable but must not deviate from the evidence base.’ Hertfordshire GP Professor Mike Kirby, a member of the Primary Care Cardiovascular Society (PCCS), said it was unwise to use old guidelines ‘because medical evidence moves on’.
‘The risk is that people will go on to use beta-blockers first line and we know they’re less effective than other drugs,’ he said.
Evidence has shown that beta-blockers give less protection against stroke than other agents and, when used with diuretics, are associated with a 50 per cent increased risk of diabetes.
The NICE/BHS guideline puts beta-blockers fourth line for uncomplicated hypertension rather than first line as before. But the GP survey found that a fifth of GPs disagreed with this decision.
Leeds GP Dr Mark Davis, who was on the NICE/BHS guideline development group said: ‘Using a beta-blocker is better than nothing. It is encouraging that the majority are giving consideration to these guidelines.’
PCCS chairman and North Yorkshire GP Dr Terry McCormack welcomed the 94 per cent uptake and said using a combination of guidelines was to be expected: ‘A guideline is just that. The best way to use it is to adapt it.’
A spokesman for NICE said: ‘It is important to emphasise that the review of the NICE guideline was limited to the pharmacological aspects of hypertension. There- fore it is not surprising that GPs will use some other guidance.’