EDITOR—The optimal lipid targets are a total cholesterol concentration of < 4.0 mmol/l or a reduction of 25% from baseline. The percentage reduction approach is needed for patients starting statin treatment for secondary prevention or because of their high cardiovascular risk but whose total cholesterol value is already close to the target. For example, for such patients starting statin treatment with a total cholesterol of 4.1 mmol/l, lowering cholesterol to 3.9 mmol/l is clearly not sufficient and a 25% reduction is required.

Many people in the United Kingdom are indeed unaware that they have a raised blood pressure and are therefore at increased risk. Most will develop more serious hypertension over time. How will that be detected without a programme of monitoring? It may not be cost effective for Green to do it, but somebody should. The “real world of general practice” cannot meet the challenges of modern health care, so changes in service delivery are needed.

The ALLHAT study is just one …