Longing for clinical excellence: a critical outlook into the NICE recommendations on hypertension management--is nice always good?

The European Society of Hypertension and the European Society of Cardiology have started the preparation of the third edition of their joint guidelines on the management of arterial hypertension. The authors have focused on the new edition of the UK NICE guidelines to learn about the difficulties of disentangling evidence from wisdom when preparing recommendations. The two areas where the NICE guidelines have changed more importantly are the use of ambulatory blood pressure in the diagnosis of hypertension and the choices of antihypertensive agents to initiate treatment (less frequent use of diuretics and preference given to chlorthalidone and indapamide). NICE recommendations on these topics appear more based on opinion than evidence. Strenuous longing for evidence and clinical excellence is certainly meritorious, but such a nice approach is not always good.