General practitioners need evidence from and about the patients they see

In this week's BMJ (p 635), Mant and colleagues raise again the question of whether large scale randomised controlled trials provide evidence relevant to primary care.1 In a cross sectional study they question whether the UK national clinical guidelines for stroke are applicable to primary care patients. These guidelines, largely based on the PROGRESS trial,1 recommend a target blood pressure of 140/85 mm Hg, with further lowering beyond this target desirable through use of a thiazide diuretic and an angiotensin converting enzyme inhibitor.2

Mant and colleagues critiqued the applicability of these guidelines to primary care patients by comparing the characteristics of patients in English general practice who had confirmed stroke with participants in the PROGRESS trial. They concluded that these populations were not sufficiently similar to warrant widespread use …