Editor—In recent years many clinical guidelines on hypertension have been published. While recommendations have often varied, hypertension guidelines share two features: all have generated controversy and been poorly implemented. Recent criticisms of hypertension guidelines by the National Institute for Clinical Excellence (NICE)1 and the British Hypertension Society (BHS),2 show that the first phenomenon is continuing to happen. Can the second be prevented?
Two developments indicate that it can.
Firstly, there is now international agreement on what constitutes a good guideline.3 Developers are encouraged to address the perspective of their target professionals, particularly assessing the resource impact of their recommendations. Both issues were at the heart of the criticisms of the BHS guidelines.2 NICE takes into account evidence of cost effectiveness as well as clinical effectiveness, which is the main reason the NICE recommendations differ from those of the BHS. However, they are not as dissimilar as Poulter says in his letter.1 It would have been surprising if they were contradictory, as the chairman of the BHS guideline development group was also a member of the NICE group.
Secondly, the complexity of implementing guidelines is being increasingly recognised. The inclusion of NICE guidance in the national standards against which the Health-care Commission will assess and monitor quality in the NHS is an important step in the right direction.4 Reducing confusion by limiting the number of hypertension guidelines is worth exploring, and the joint working between NICE and the British Thoracic Society in updating its guideline on chronic obstructive pulmonary disease as a NICE guideline is a model worth emulating for the management of hypertension.5
Competing interests: PL, GL, and AS are employed by NICE. PL was the initial coordinator of the AGREE Project and is a founding trustee of the AGREE Research Trust.
References
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