Personal Views

Abandoning diastole

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7200.1773 (Published 26 June 1999) Cite this as: BMJ 1999;318:1773
  1. Peter Sever, professor of clinical pharmacology and therapeutics
  1. London, and past president of the British Hypertension Society

    Whenever possible medical practice should be evidence based. Hypertension is one of the world's most common causes of premature morbidity and mortality, and national and international bodies have published guidelines on hypertension management.

    Around 70% of people with known hypertension are uncontrolled

    Recent guidelines have proposed that decisions on management of hypertension should take into account estimates of absolute cardiovascular risk based on an assessment of concomitant risk factors, including lipid profile, smoking habits, and the presence or absence of diabetes. While this has certain merits on scientific grounds, recommendations based on assessment of five year absolute risk ignore longer term benefits of intervention (life years saved) for younger patients who wouldbe denied treatment if shorter term estimates of risk were used.

    This confusion among doctors and uncertainties about treatment strategies must be a major explanation underlying the appalling levels …

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