PATHWAY hypertension study

Prevention And Treatment of Hypertension With Algorithm-based therapY

The PATHWAY study was designed by the British Hypertension Society Research Working Party, and is funded by a 1.74 million grant from the British Heart Foundation. It is based in 8 UK centres: Cambridge, Dundee, Edinburgh, Glasgow, Leicester and 3 centres in London. The chief investigator is Prof. Morris Brown of the University of Cambridge.

PATHWAY comprises three clinical trials of licensed medicines, which aim to address some important areas of uncertainty in the current management of hypertension:

  1. Monotherapy vs. dual therapy for initial treatment for hypertension
  2. Optimal treatment of drug resistant hypertension
  3. Comparison of single and combination diuretics in low-renin hypertension

Click on studies listed above for more details about the different components of PATHWAY.

About the studies

The 2006 NICE/BHS hypertension guidelines use the "ACD" rule for managing hypertension. This is a simple algorithm which uses ACE inhibitors (or angiotensin receptor blockers), Calcium channel blockers and Diuretics in a logical, stepwise manner to control blood pressure.

ABCD rule

The studies are designed to address the areas of uncertainty shown above - namely:

  1. Should we start with monotherapy (as we usually do at present) for the initial management of hypertension, or should we jump to dual therapy straightaway?
  2. What is the best management for patients with elevated blood pressure, resistant to treatment with ACE inhibitors, calcium channel blockers and thiazide-type diuretics?
  3. Do potassium sparing diuretics reduce the risk of developing glucose intolerance (a recognised problem with thiazide diuretics), and does combining diuretics improve their safety and efficacy?

More information about the three studies can be found using the menu on the left.

PATHWAY in Edinburgh

Recruitment began in Edinburgh in 2010. We aim to recruit around 200 patients over a 2-year period. The study will be recruiting in a primary care setting, from 8 or more GP surgeries around the Edinburgh area. 25 or so patients will be required from each practice.

Patient groups

Patients with essential hypertension from the following treatment groups will be recruited:

  • untreated
  • suboptimal monotherapy
  • suboptimal dual therapy (ACE inhibitor + calcium channel blocker)
  • resistant hypertension (ACE inhibitor + calcium channel blocker + diuretic)

How can I get involved?

If you are a GP practice in the Edinburgh/Lothian area, and would be keen to find out more, please email or write to the Clinical Pharmacology Unit using the details available on the contacts page.

Funding and support

PATHWAY was designed by the British Hypertension Society Research Working Party, and is funded by the British Heart Foundation.

British Heart Foundation British Hypertension Society

Self-blood pressure monitors for PATHWAY are being provided by Microlife - WatchBP.


Non-invasive arterial stiffness measurements by TensioClinic Arteriographs are provided for PATHWAY by Unimedic Ltd in association with the Hungarian Society of Arterial Stiffness.

Unimedic Hungarian Society of Arterial Stiffness