The British Hypertension Society (BHS) has released updated guidelines for hypertension management (BHS-IV), emphasizing the importance of blood pressure as a risk factor for cardiovascular disease and the need for multifactorial interventions. The guidelines aim to improve the detection, treatment, and control of hypertension, particularly in high-risk groups such as those with diabetes. Key recommendations include: 1. **Treatment Algorithm**: The BHS recommends a treatment algorithm based on the AB/CD rule, which categorizes antihypertensive drugs into four classes (A: angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers; B: β-blockers; C: calcium channel blockers; D: diuretics) to optimize blood pressure control. 2. **Lifestyle Modifications**: All hypertensive patients should be advised on lifestyle changes, including diet and exercise, to reduce blood pressure and cardiovascular risk. 3. **Drug Treatment**: Drug treatment is recommended for patients with sustained systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥100 mmHg. For those with systolic blood pressure 140-159 mmHg or diastolic blood pressure 90-99 mmHg, treatment should be considered if there are complications or a 10-year cardiovascular disease risk ≥20%. 4. **Optimal Blood Pressure Targets**: For most patients, the optimal target is systolic blood pressure ≤140 mmHg and diastolic blood pressure ≤85 mmHg. For patients with diabetes, organ impairment, or established cardiovascular disease, a lower target of ≤130/80 mmHg is recommended. 5. **Meta-Analyses and Drug Choice**: Recent meta-analyses show that the main benefit of blood pressure lowering is the reduction in blood pressure itself, with little evidence of additional benefits specific to any drug class. The choice of drug should consider patient-specific factors and contraindications. 6. **Follow-Up and Implementation**: Regular follow-up is essential to monitor blood pressure and adherence to treatment. Effective implementation requires multidisciplinary teams and extended roles for healthcare professionals. These guidelines are intended for general practitioners, practice nurses, and hospital generalists, and aim to improve the management of hypertension and reduce cardiovascular events in the population.The British Hypertension Society (BHS) has released updated guidelines for hypertension management (BHS-IV), emphasizing the importance of blood pressure as a risk factor for cardiovascular disease and the need for multifactorial interventions. The guidelines aim to improve the detection, treatment, and control of hypertension, particularly in high-risk groups such as those with diabetes. Key recommendations include: 1. **Treatment Algorithm**: The BHS recommends a treatment algorithm based on the AB/CD rule, which categorizes antihypertensive drugs into four classes (A: angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers; B: β-blockers; C: calcium channel blockers; D: diuretics) to optimize blood pressure control. 2. **Lifestyle Modifications**: All hypertensive patients should be advised on lifestyle changes, including diet and exercise, to reduce blood pressure and cardiovascular risk. 3. **Drug Treatment**: Drug treatment is recommended for patients with sustained systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥100 mmHg. For those with systolic blood pressure 140-159 mmHg or diastolic blood pressure 90-99 mmHg, treatment should be considered if there are complications or a 10-year cardiovascular disease risk ≥20%. 4. **Optimal Blood Pressure Targets**: For most patients, the optimal target is systolic blood pressure ≤140 mmHg and diastolic blood pressure ≤85 mmHg. For patients with diabetes, organ impairment, or established cardiovascular disease, a lower target of ≤130/80 mmHg is recommended. 5. **Meta-Analyses and Drug Choice**: Recent meta-analyses show that the main benefit of blood pressure lowering is the reduction in blood pressure itself, with little evidence of additional benefits specific to any drug class. The choice of drug should consider patient-specific factors and contraindications. 6. **Follow-Up and Implementation**: Regular follow-up is essential to monitor blood pressure and adherence to treatment. Effective implementation requires multidisciplinary teams and extended roles for healthcare professionals. These guidelines are intended for general practitioners, practice nurses, and hospital generalists, and aim to improve the management of hypertension and reduce cardiovascular events in the population.