Audit of use of ACE inhibitors and monitoring in general practice

BMJ 1999;318:1697 ( 19 June )

Letters

Audit of use of ACE inhibitors and monitoring in general practice

Guidelines on monitoring, on their own, are not sufficient

Authors' reply

Guidelines on monitoring, on their own, are not sufficient

The first 150 words of the full text of this article appear below.

EDITOR $---$ Kalra et al's paper describing an audit of monitoring renal function in general practice suggests that practice isoften less than optimal, although associated with some uncertainty.¹Unfortunately, the authors do not give confidence intervals aroundtheir estimates of effect $---$ which we provide here. The fact thatonly 34% (95% confidence interval 28% to 39%) of practitionerschecked renal function after initiating angiotensin convertingenzyme inhibitors and 15% (11% to 19%) never checked it is animportant finding. We disagree, however, with the authors' conclusionthat producing guidelines on monitoring, on its own, will leadto an improvement inpractice.

The authors state that renal monitoring has been neglected in recent guidelines and cite the North of England evidence basedguidelines on the use of angiotensin converting enzyme inhibitorsin primary care (to which we contributed) as an example of this.²They recommend that "renal function should be . . . [Full text of this article]

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