Treating hypertension with guidelines in general practice

doi:10.1136/bmj.329.7465.523

BMJ 2004;329:523-524 (4 September), doi:10.1136/bmj.329.7465.523

Editorial

Treating hypertension with guidelines in general practice

Patients decide how low they go, not targets

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

Following the issue of two new hypertension guidelines in theUnited Kingdom this year, we need to consider how they havebeen received by their main audience—primary care.^1
2Not too brightly, it seems.³ Differences in recommendationscause some irritation, but the main source of disaffection is,once again, targets. The rule of halves—part of whichstates that only half of patients with high blood pressure reachedtarget blood pressure—was first described more than 30years ago and now seems redolent of a distant golden age ofsuccess.⁴ With newer, more stringent targets, hypertension iscontrolled in only a third of our patients who receive treatmentfor it.⁵ Viewed from general practice, it seems that most articleson hypertension—including this one—begin by remindingus of our failures. But is this justified?

While plenty of strong evidence shows the benefits of loweringblood pressure, targets—and their ceaseless revision—areless evidence based. . . . [Full text of this article]

Neil C Campbell, senior lecturer

Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen AB25 2AY, (n.campbell@abdn.ac.uk)

Peter Murchie, Cancer Research UK research training fellow in primary care oncology

Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen AB25 2AY, (p.murchie@abdn.acuk)

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A flawed model?: Malcolm E Kendrick
bmj.com, 3 Sep 2004 [Full text]
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