Sir,

As Jeanne Lenzer reports, [1] a recent Cochrane review of randomised controlled trials has shown no benefit from long-term drug treatment of patients with mild hypertension in terms of reductions in heart disease, stroke or total mortality. [2]

These findings are a shocking indictment of modern medical practice. How many people with mild hypertension have been treated? How many have suffered from side-effects of drugs without any prospect of benefit? And how many have had to pay for unnecessary prescriptions? Were the patients provided with accurate information with which to make an informed decision about commencing long-term treatment? Or were they misled? In this context, it is of particular concern that general practitioners receive additional payment for identifying and treating risk factors for cardiovascular disease.

Perhaps, though, the most astonishing aspect of Lenzer’s article is the comment, attributed to James Wright, coordinating editor of the Cochrane Hypertension Group, that, “… until now it has simply been assumed that treating mild hypertension, which is what most hypertensive patients have, is beneficial.” [1] So much for evidence-based medicine.

The fault lies with the researchers who, in their publications, blur the type of patients to whom the results apply. It also lies with the writers of guidelines who, in their efforts to inflate the importance of their work, ignore the lack of evidence of benefit in subgroups and generalise their recommendations too broadly. And it lies with the pharmaceutical industry that makes no attempt to target products to those patients who would benefit and, instead, distributes drugs as widely as possible to maximise profits. [3] But others cannot escape responsibility. What about the doctors who prescribe the drugs without satisfying themselves about the evidence? And what about those who drive forward the national strategies for managing cardiovascular disease?

Countless patients across the country – not to mention many more around the world – have been prescribed treatment based not on evidence but on an assumption. How many other such scandals will be uncovered in the future?

James Penston
james.penston@nhs.net

References

1. Lenzer J, Cochrane review finds no proved benefit in drug treatment for patients with mild hypertension. BMJ 2012;345;e5511.

2. Diao D, Wright JM, Cundiff DK, Gueyffier F. Pharmacotherapy for mild hypertension (Review). Cochrane Database Syst Rev 2012;(8):CD006742.

3. Penston J. Stats.con – How we’ve been fooled by statistics-based research in medicine. The London Press, November 2010.

Competing interests: None declared