NICE downgrades beta-blockers

Draft joint hypertension guidelines from NICE and the British Hypertension Society (BHS) have deemed beta-blockers largely ineffective.

The joint guidance, published earlier this week, is intended to clear up the confusion caused by previous conflicting NICE and BHS guidance.

The draft largely backs existing BHS recommendations but makes calcium channel blockers a first- or second-line treatment, and relegates beta-blockers to fourth-choice therapy, largely based on evidence from the ASCOT trial.

ASCOT suggested that, compared with other treatments, beta-blockers increased the risk of stroke, unstable angina, revascularisation procedures, and early-onset diabetes (GP, 9 September, 2005).

Professor Morris Brown, president of the BHS, said that having guidelines supported by NICE and BHS would make things clearer for GPs but he added that trials showing beta-blockers to be ineffective had only looked at atenolol.

Dr Phil Alderson, associate centre director for guidelines methodology at NICE, said: 'Most of the evidence did come from atenolol trials, and there was some concern about how generalisable that evidence was. But the committee decided that until new data showed other beta-blockers should be used earlier, all these drugs should be fourth-line.'

Dr Alderson added that NICE would produce more joint guidance in future to avoid conflicts.

The consultation on the draft hypertension guidance ends on 20 March, with the final version due to be published in May.


- ACE inhibitors (A) first choice for white under-55s, followed by a calcium-channel blocker (C) and/or thiazide-type diuretic (D).

- C or D first choice for white over-55s and black patients, followed by A, then C or D.

- Beta-blockers (B), alpha-blockers or further diuretics considered only as fourth-line option for all.

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