The current British Hypertension Society (BHS) Guidelines for the management of Hypertension run to an impressive 46 pages.1 The Quick Reference Guide on management of hypertension in adults in primary care published by the National Institute of Health and Clinical Excellence (NICE) in June 2006 is shorter at 11 pages.2 Both documents give essentially the same message about thresholds, treatments, and targets for hypertensive patients with the NICE guide providing easy to follow, colourful flow diagrams. By definition clinical guidelines need to be clear and user-friendly but I worry that important and subtle messages may be lost completely in the process. A case in point is the management of hypertension in young women of childbearing age. In the NICE Quick Reference Guide only one line mentions this group saying that beta blockers should be avoided in women of childbearing age. There is no mention of why and no reference to the potential dangers of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) should these women become pregnant.
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