Here's to risk assessment

doi:10.1136/bmj.39339.477581.3A

BMJ 2007;335:577-578 (22 September), doi:10.1136/bmj.39339.477581.3A

Letters

Cardiovascular prevention

Here's to risk assessment

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

I was delighted to read the editorial suggesting that we shouldmove away from the primitive "one threshold fits all" mentalityfor starting antihypertensive treatment and take a view basedon the overall cardiovascular risk.¹ We already do this whentreating cholesterol for the purposes of primary prevention,so it is inconsistent not to use this approach for blood pressure,which is another continuous variable. The recent Joint BritishSocieties' guidelines recognise this as the predicted cardiovascularrisk rises with systolic blood pressure to 160 mm Hg,² yet theyare not used as a tool for assessing whether to treat hypertension.

This is part of the general problem that occurs when we assignarbitrary values to continuous and often fluctuating biologicalvariables to create boundaries for disease labels. For example,bronchial hyper-reactivity can change quite notably over time,and it can be very difficult to decide whether the label of. . . [Full text of this article]

Jonathan D Sleath, general practitioner

Hereford HR2 9HN

jonathan.sleath@nhs.net