Abstract: . . .  thiazide-type diuretic to reduce the patients risk of developing diabetes. C R9 In patients whose blood pressure is not controlled (ie over 140/90 mmHg) despite a treatment regimen including a beta-blocker, treatment should be revised according to the treatment algorithm (see Figure 2). C R10 In patients whose blood pressure is well-controlled (ie 140/90 mmHg or lower) with a regimen which includes a beta-blocker, long-term management should be considered as part of their routine review. In these patients, there is no absolute need to replace the beta-blocker with an alternative agent. C 17 1 Pharmacological interventions * Including both Black African and Black Caribbean patients, not Asian, Chinese, mixed-race, or other ethnic groups. ** Or an angiotensin-II receptor antagonist if an ACE inhibitor is not tolerated. Page 22 R11 When a beta-blocker is withdrawn, the dose should be stepped down gradually. Beta-blockers should not be withdrawn in patients with compelling indications for beta-blockade, for example those who have symptomatic angina or who have had a myocardial infarction. C 1.6 Recommendations that are not changing The GDG is not proposing to change the following recommendations from section 1.4 of the original NICE clinical guideline on hypertension in primary care (CG 18). These recommenda- tions will still apply after publication of the updated guideline, and are not part of the consultation. 1.4.1 Drug therapy reduces the risk of cardiovascular disease and death. Offer drug therapy to: A patients with persistent high blood pressure of 160/100 mmHg or more patients a . . .
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