Letter

Problems with guidelines

BMJ 1997; 314 doi: 10.1136/bmj.314.7079.518a (Published 15 February 1997)
Cite this as: BMJ 1997;314:518.2

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Hypertension guidelines should not reflect suboptimal practice

  1. Andrew H Shennan, Clinical lecturer in obstetrics and gynaecologya
  1. a Institute of Obstetrics and Gynaecology, Royal Postgraduate Medical School, Queen Charlotte's and Chelsea Hospital, London W6 0XG
  2. b National Agency for Development of Medical Evaluation, 75640 Paris cedex 13, France
  3. c Jean Minjoz University Hospital, 25 000 Besançon, France

    Editor—T J Scanlon and colleagues point out that blood pressures taken in normal practice may differ from those obtained in clinical trials.1 Their evidence is based on the fact that clinicians in West Sussex used Korotkoff phase IV to measure diastolic blood pressure, while recommended guidelines are based on phase V and are therefore “artificially high.” There has been controversy over whether to use Korotkoff phase IV or phase V since 1912, but current recommendations based on sound epidemiological, therapeutic, and clinicopathological evidence strongly favour the use of phase V.2

    Colleagues and I have recently published evidence3 (which was highlighted in an editorial by Peter Rubin4) that phase IV cannot be adequately reproduced between observers. Although our paper primarily concerned pregnancy (for which the use of phase IV has been recommended), we showed …

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