eMedinewS Editorial

Health Care 205 Comments

Recommendations on initial choice of antihypertensive drug
class (ABCD rule) as per NICE guidelines

  • In patients aged =55 years or in black (African or Afro-Caribbean descent) patients of any age, the first choice for initial treatment should be either a C (calcium channel blocker) or a D (thiazide-type diuretic) drug.
  • In patients aged <55 years, the first choice for initial treatment should be an A drug (ACE inhibitor or an ARB if an ACE inhibitor is not tolerated).
  • If initial treatment was with a C or D drug and a second drug is needed, add an A drug (ACE inhibitor, or an ARB if an ACE inhibitor is not tolerated).
  • If treatment was started with an A drug, add a C or D drug.
  • If treatment with three drugs is needed, the combination of A, C, and D drugs should be used.
  • B drugs (ß blockers) should be reserved for patients for whom there is a separate indication additional to hypertension, and for combination therapy.
  • (Source: BMJ, April 16)

Dr KK Aggarwal
Editor in Chief