Exclusive: Beta-blocker advice 'premature'

NICE was premature in downgrading beta-blockers as a preferred treatment for hypertension, a leading expert has claimed.

President of the European Society of Hypertension (ESH) Professor Anthony Heagerty said NICE should consider further research showing beta-blockers can treat uncomplicated hypertension.

NICE/British Hypertension Society (BHS) guidelines on the management of the condition, issued in June last year, recommend either a calcium channel blocker or a thiazide diuretic as the first- or second-line treatment, downgrading beta-blockers to fourth choice.

Beta-blockers were downgraded after the ASCOT trial found that they increased the risk of stroke, unstable angina, and early-onset diabetes more than other treatments.

However, Professor Heagerty believes NICE should consider research used in ESH guidance.

'The ESH guidelines for hypertension do not shy away from the use of beta-blockers, stating that they can be used at any time,' he said. 'Beta-blockers are not as disappointing as people suggest, nor is the evidence about them as clear-cut as NICE believes.'

Beta-blockers were cost-effective, due to the availability of cheap generics, and had benefits to patients, said Professor Heagerty. 'They are extremely effective in the secondary prevention of heart disease.'

But Professor Brian Williams, from the University of Leicester, who chaired the NICE/BHS guidance working party, said: 'The NICE guidance is the best and most comprehensive review of the evidence.'

A GP survey, conducted last November, revealed that a fifth of GPs disagreed with the decision to make beta-blockers fourth choice.

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