What is the recommendation for step 2 and step 3 treatment for hypertension?
The committee agreed that, in the absence of evidence of which treatment(s) are most effective for step 2 or step 3, the recommendation should be to offer any of these treatments based on an individualised approach informed by risks and benefits of each treatment and the person with hypertension's preference. The committee noted that the changes to the step 1 recommendations for some people with type 2 diabetes do not necessitate a change in the step 2 recommendations since the same options for combination treatment at step 2 are available. The committee agreed that the choice of drug should be discussed and agreed with the person, based on the person's step 1 treatment, the risks and benefits of each treatment option, and taking into account the person's preferences and other clinical factors. The updated recommendations reflect this, giving the choice of possible treatment options. A NICE patient decision aid on treatment choices for high blood pressure has been developed to support healthcare professionals and people with hypertension to discuss their treatment options and make informed decisions.