MORE than 1.5 million people using beta-blockers to treat high blood pressure are to be eased off the medication after the publication of guidance recommending newer treatments.

Guidelines from the National Institute for Health and Clinical Excellence (NICE), released today, advise the use of a combination of hypertensive treatments involving calcium channel blockers, ACE inhibitors and diuretics.

Family doctors are advised not to prescribe beta-blockers as the routine “first-line” therapy for high blood pressure in favour of other treatments because the medication “performs less well, particularly in the elderly . . . and carries an unacceptable risk of provoking type 2 diabetes”.

Of the two million patients taking beta-blockers, only the minority who control their blood pressure to a comparable standard as on the other drugs need not change medication.

Some people who take the drugs for conditions such as angina and anxiety will be unaffected, while beta-blockers are also still considered the best option for young women who may become pregnant.

The latest NICE review, described as one of the most significant since the organisation was founded, comes after research showed that taking newer drugs cuts the risk of heart attacks and strokes by half when compared with older treatments.

About half of the estimated 18 million Britons — 40 per cent of adults — with hypertension are on medication. The condition is a leading cause of preventable death and disability. The guidelines, published by NICE and the National Collaborating Centre for Chronic Conditions, in conjunction with the British Hypertension Society, recommend a combination of newer treatments, which act to regulate the hormonal system and open up blood vessels.

People over 55, and all Afro-Caribbean hypertensives who are more at risk, are recommended initial therapy of calcium channel blocker or thiazide diuretic. First choice for younger people is an ACE inhibitor or, if this is not tolerated, an Angiotensin receptor blocker. Bryan Williams, Professor of Medicine at University Hospitals of Leicester NHS Trust and a member of the guideline development group, said that the cost of implementing the changes would be about £58 million. Later cost savings are estimated at about £250 million.

“This is a hugely important step for people with hypertension and the healthcare professionals who treat them,” Professor Williams said. “This new guidance has benefited from a rigorous evaluation of the evidence and has resulted in a simple, pragmatic and practical approach to treating blood pressure, one of the most important causes of premature death in the UK.

“In addition, the recommendations have undergone a cost-effectiveness analysis which has reinforced the guidance.”

The Blood Pressure Association urged patients on beta-blockers not to panic: “What we are saying is that there are newer, more effective drugs available and patients should talk to their health professionals about that,” Last year the Anglo-Scandinavian cardiac outcomes trial, the largest study of high blood pressure conducted in Europe, revealed that a combination of new hypertension drugs and a common statin used to lower cholesterol cuts the chances of a heart attack or stroke by almost two thirds. The study, involving more than 19,000 patients, prompted NICE to take the rare step of forming an expert group immediately to advise on the impact of the new data, while the Data Safety Monitoring Board decided to end the trial early to allow all the patients the opportunity to take up the treatment strategy.

Peter Littlejohns, the clinical and public health director at NICE, said that “significant new data” had made the review necessary.

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