I read with interest the response to the Guidelines on hypertension.
The response robustly defends the recommendations quote the available
evidence. However, this response did not address the very legitimate
concerns raised by the GP writers who actually deliver hypertensive care
in the UK.
All “evidence” is merely modelling and interpretation depends on your
standpoint on acceptable risk. The evidence should seen in context and not
as simple “fact”. ALLHAT and WOSCOP are important studies that counter the
widespread use of statins in primary prevention. Even the ASCOT-LLA study
which is quoted as “fully justifies considering statin treatment” with a
“10 year cardiovascular disease risk is estimated to be 20%, irrespective
of baseline cholesterol values” is not what it seems. Consider that
treatment with a statin has a non significant impact on all cause
mortality, the NNT per year is 300 for the primary endpoint and lastly
the average age of patients was 63 hardly “fully justices” widespread
statin use.
We in “GP land” may not have the trappings of academia but we know
our communities and tickbox guidelines is not medicine despite the
“evidence” otherwise.
Rapid Response:
Risky Relative Risk
I read with interest the response to the Guidelines on hypertension.
The response robustly defends the recommendations quote the available
evidence. However, this response did not address the very legitimate
concerns raised by the GP writers who actually deliver hypertensive care
in the UK.
All “evidence” is merely modelling and interpretation depends on your
standpoint on acceptable risk. The evidence should seen in context and not
as simple “fact”. ALLHAT and WOSCOP are important studies that counter the
widespread use of statins in primary prevention. Even the ASCOT-LLA study
which is quoted as “fully justifies considering statin treatment” with a
“10 year cardiovascular disease risk is estimated to be 20%, irrespective
of baseline cholesterol values” is not what it seems. Consider that
treatment with a statin has a non significant impact on all cause
mortality, the NNT per year is 300 for the primary endpoint and lastly
the average age of patients was 63 hardly “fully justices” widespread
statin use.
We in “GP land” may not have the trappings of academia but we know
our communities and tickbox guidelines is not medicine despite the
“evidence” otherwise.
Competing interests:
None declared
Competing interests: No competing interests