BMJ  2005;331:1022-1023 (29 October), doi:10.1136/bmj.331.7523.1022-b

Letter

ASCOT: a tale of two treatment regimens

Odds are that it's hype

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

EDITOR—The editorial on ASCOT seems to back hype rather than evidence based medicine.¹ The 2004 update of the British Hypertension Society's guideline recommends first line use of angiotensin modifying drugs in non-black people younger than 55, apparently on the basis of a study with 56 patients that looked at blood pressure response.² The contemporaneous recommendations from the National Institute for Health and Clinical Excellence (NICE), based on a big review that looked at tens of thousands of subjects in studies examining the clinical outcomes of death, stroke, and myocardial infarction, concluded that thiazides are the most cost effective first line treatment for most people,³ with either angiotensin converting enzyme (ACE) inhibitors or blockers added in, at the next step.

Should ASCOT change the NICE conclusion? In the previous issue of the BMJ an article by Freemantle exhorted caution about reading too much into a study that did not . . . [Full text of this article]

Meddygfa Gyffin, Conwy LL32 8LT martin@theduerdens.co.uk

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