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PRIMARY CARE: R J McManus, J Mant, A Roalfe, R A Oakes, S Bryan, H M Pattison, and F D R Hobbs Targets and self monitoring in hypertension: randomised controlled trial and cost effectiveness analysis BMJ 2005; 331: 493 [Abstract] [Full text]

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Achieving BP Targets

Scot A Garg, Adil Khan. RJI Bain   (5 September 2005)

Illinformed advice from health professionals

Rupert A Gude   (7 September 2005)

Achieving BP Targets 5 September 2005
Scot A Garg, SpR Cardiology Diana Princess of Wales Hospital, Scartho Rd, Grimsby, DN33 2BA, Adil Khan. RJI Bain Send response to journal: Re: Achieving BP Targets	Dear Editor, I read this paper with great interest. We have performed an audit looking at patient's perception of their blood pressure (BP) using the notion mentioned in your paper that patient's having an interest in their BP would be more likely to achieve target BP. The audit of hypertensive patients was performed in a Cardiology out patients setting and a parallel study was performed on the General medical wards. Results were surprisingly similar in both groups of patients. Overall only 55% of patients had control of their BP; with 35% of patients falsely thinking their BP was within target limits. The number of patients aware of the target BP was not surprisingly a dismal 25%; but those aware of it were more likely to achieve it. A surprising result was that patients who made a recording of their BP; although more likely to be aware of the actual reading, they were not any more likely to achieve the target BP. Only 60% of patients knew why BP control was important. Patient education about the risks of blood pressure should surely play a role in increasing awareness about the risks of this silent disease, and should be the starting point in helping improve the numbers achieving target levels. Patients need to be informed of the actual BP reading when it is taken and told how high this is above the 'normal'. A simply analogy such as using the speed of a car above the speed limit will help patient's get a true understanding what their 160 over 90 reading actually means. Currently they leave their consultation will no real understanding as to how high their blood pressure is, as they have no feel for the numbers they are told; in the instances when they are actually told the BP reading. In this day where more algorithms are being produced to treat blood pressure; and more and more money is being spent on treating BP are we not in danger of the missing the point; and as a result never aspiring to improve BP control? Competing interests: None declared
Illinformed advice from health professionals 7 September 2005
Rupert A Gude, General Practitioner Abbey Surgery, Tavistock, Devon ,PL19 9EL Send response to journal: Re: Illinformed advice from health professionals	One of the problems associated with patients lack of knowledge about the importance of different levels of blood pressure is the poor information they receive from some health professionals who take their blood pressure. There is still a persistance of the myth of 100 plus your age and everyone taking blood pressures needs to be aware of the modern guidelines and give appropriate responses to the patient. When my blood pressure was done before a rheumatology out patient clinic, I was told it was alright but on further questioning was told it was 154/92. Similarly a locum health care assistant in our practice told one of our diabetics that her blood pressure of 152/88 was good. Clear written guidelines need to be produced for patients monitoring their own blood pressure which also includes a sentence on the difference btween surgery and home readings (as can be found in BHS guidelines 1V). Something for the British Heart Foundation? Competing interests: None declared