Guidelines for managing raised blood pressure

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7049.64 (Published 13 July 1996) Cite this as: BMJ 1996;313:64
  1. Rodney T Jackson,
  2. David L Sackett
  1. Associate professor Department of Community Health, University of Auckland, Auckland, New Zealand
  2. Professor NHS Research and Development Centre for Evidence Based Medicine, Oxford Radcliffe NHS Trust, Oxford OX3 9DU

    Evidence based or evidence burdened?

    Randomised controlled trials have consistently shown that lowering blood pressure by about 10-12 mm Hg systolic and 5-6 mm Hg diastolic reduces the relative risk of stroke by about 40% and of coronary disease by about 15%.1 This relative reduction in risk is similar whatever the blood pressure before treatment and the absolute risk of cardiovascular disease. Moreover, the reduction in risk occurs surprisingly quickly; the average time from the start of treatment to a significant impact on major cardiovascular outcomes is only about two and a half years.

    This convincing evidence of a large and rapid relative benefit from treatment has led national and international bodies to recommend that a substantial proportion of adults be considered for long term drug treatment. In 1993 at least one international and three national guidelines on managing raised blood pressure were published.2 3 4 5 All were based on the same data, yet when Fahey and Peters (p 93) applied the various guidelines to a typical population of patients treated for hypertension in British general practice, only about a third of the patients met the treatment criteria of all four guidelines.6

    The authors of all of these guidelines (including one …

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