Management of hypertension

doi:10.1136/bmj.320.7234.576

BMJ 2000;320:576 ( 26 February )

Letters

Management of hypertension

Ideal body weight is not realistic goal for lifestyle intervention

Patients from ethnic minorities are at greater risk

Guidelines have serious weaknesses

Guidelines do not consider workload implications in primary care

Non-medical remedies should be considered first

Evidence shows that calcium antagonists reduce cardiovascular end points in diabetic patients

Optimal target pressure is not supported by strength A evidence

"Mortality" is preferable to "major disease end points"

Trials showing no reduction in mortality do not receive same exposure

Authors' reply (Psaty and Furberg)

Authors' reply (Ramsay et al)

Ideal body weight is not realistic goal for lifestyle intervention

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

EDITOR $---$ Ramsay et al have produced a clear and authoritative document with their recent guidelines for the treatment of hypertension.¹The section on lifestyle modification, however, includes the statementthat weight loss to achieve an ideal body weight will lower bloodpressure.

Although this is undoubtedly true, it undermines most recent guidelines that recognise the practical near impossibility ofachieving ideal body weight in most obese subjects^2-4 and evidencethat suggests that more modest (and achievable) reductions inweight of 5-10% of body weight can be effective at lowering systolicand diastolic blood pressure in the range of 4-7 and 3-6 mm Hgrespectively.⁵ It should be made explicit in the guidelinesthat this degree of weight loss is likely to be beneficial inreducing cardiovascular risk, rather than perpetuating the myththat "ideal" body weight is a realistic goal of lifestyle modificationin overweight and obesesubjects.

John Wilding, senior lecturer in medicine.
j.p.h.wilding@liv.ac.uk

Gareth Williams, professor.
University Clinical Departments, University Hospital Aintree, Liverpool L9 7AL

Competing interests: Both authors have received honoraria for speaking at lectures, consultancy fees, and grant support froma number of companies that produce, or are developing, pharmacologicaltreatments forobesity.

1.	Ramsay LE, Williams B, Johnston GD, MacGregor GA, Poston L, Potter JF, et al. British Hypertension Society guidelines for hypertension management 1999: summary. BMJ 1999; 319: 630-635[Free Full Text]. (4 September.)
2.	Royal College of Physicians. Clinical management of overweight and obese patients, with particular reference to the use of drugs. London: Royal College of Physicians, 1998.
3.	Obesity in Scotland: integrating prevention with weight management. Edinburgh: SIGN, 1996.
4.	Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults. Bethesda, MD: National Institutes of Health, 1998.
5.	Trials of Hypertension Collaborative Research Group. Effects of weight loss and sodium reduction intervention in blood pressure incidence in overweight people with high-normal blood pressure: the trials of hypertension prevention, phase 2. Arch Intern Med 1997; 157: 657-667[Abstract].

Patients from ethnic minorities are at greater risk

EDITOR $---$ The . . . [Full text of this article]

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?

Relevant Articles

Management and preferences
BMJ 2000 320: 0. [Full Text] [PDF]

Management and preferences
BMJ 2000 320: 0. [Full Text] [PDF]

British guidelines on managing hypertension: Bruce M Psaty and Curt D Furberg
BMJ 1999 319: 589-590. [Extract] [Full Text] [PDF]

British Hypertension Society guidelines for hypertension management 1999: summary: Lawrence E Ramsay, Bryan Williams, G Dennis Johnston, Graham A MacGregor, Lucilla Poston, John F Potter, Neil R Poulter, and Gavin Russell
BMJ 1999 319: 630-635. [Extract] [Full Text] [PDF]