Published 29 June 2009, doi:10.1136/bmj.b2598
Cite this as: BMJ 2009;338:b2598

Letters

Drug prevention of hypertension

Best use of resources?

The first 100% of the full text of this article appears below.

Are there any outcome or tolerability data from large trials of antihypertensive agents in normotensive people? If not, to adopt the recommendations of Law and colleagues means the classic error of generalising from one population to another—in this case, from the hypertensive to the normotensive population.¹

Furthermore, patients prescribed antihypertensive drugs are likely to feel medicalised, and a substantial number are likely to interpret any number of temporally related physical changes as being due to the drug, whether physiologically plausible (dizziness, cough, erectile dysfunction, oedema, polyuria, rash) or not (any primary care doctor can provide multiple examples). They will return for changes in treatment, reassurance, and further evaluation, diverting resources which might be better used elsewhere.

Cite this as: BMJ 2009;338:b2598

¹ Medical University of South Carolina, Flowertown University Family Medicine, Summerville, SC 29483, USA

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Competing interests: None declared.

1. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009;338:b1665. (19 May.)[Abstract/Free Full Text]

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Authors’ reply

Malcolm Law, Joan K Morris, and Nicholas Wald
BMJ 2009 338: b2602. [Extract] [Full Text]

Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies

M R Law, J K Morris, and N J Wald
BMJ 2009 338: b1665. [Abstract] [Full Text] [PDF]

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