I thank Ms Lenzer for expanding on the issue of the authors’ conclusion and feel that it raises interesting questions about the interpretation of results when one author is recommending dramatic changes to current practice and another is being rather more prosaic.

There is one point that I feel I didn’t make strongly enough in my initial response and so would like to expand further. In my view, the Cochrane review adds nothing to the current evidence base on how to treat Stage 1 hypertension. The question it asked can be summarised as ‘if patients with Stage 1 hypertension are inappropriately prescribed outdated medication regimes do they demonstrate a reduced number of cardiovascular events?’ In fact, due to the inclusion of some patients with high cardiovascular risk and the low number of events recorded, even this question is not satisfactorily answered.

Competing interests: None declared