BMJ  2004;329:111 (10 July), doi:10.1136/bmj.329.7457.111-b

Letter

Brief lifestyle interventions for hypertension

Opportunity to provide useful information has been missed

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

EDITOR—Little et al address an important topic in their trial of dietary advice for patients with a single high blood pressure reading in primary care.¹ Robust evidence from randomised controlled trials of the effectiveness of nurse led hypertension management in primary care is lacking.² No mention is made of a possible cluster effect of different practices, neither do the authors clarify whether randomisation was balanced within practices. Neither nurses assessing outcomes nor patients were blinded to the intervention arm.

The entry assessment of blood pressure does not follow guidelines from the British Hypertension Society (neither does that at six months), which indicates that at least two measurements (1-2 minutes apart) should be taken on each occasion.³ The patients enrolled would probably have had normal blood pressure and therefore would have been less likely to respond to treatment, since the blood pressure response to any treatment . . . [Full text of this article]

Department of Community Health Sciences, St George's Hospital Medical School, London SW17 0RE sghq200@sghms.ac.uk

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