Role of the laboratory in disseminating and implementing guidelines
The authors are to be complemented on producing clear, concise, and
pragmatic guidelines on the management of hypertension within the context
of atherosclerotic risk .
We agree that implementation of their guidelines will largely depend
on efforts of doctors and nurses in primary care. We, however, suggest
that the laboratory should play a role in implementing these guidelines.
An individualised calculated coronary heart disease (CHD) risk score is
preferable to assessing risk from tables  but requires the
practitioner to collate and enter clinical and biochemical data. As part
of the Wolverhampton CHD prevention initiative, our laboratory provides
General Practitioners with an individualised laboratory-based CHD risk
score using the Framingham equations . If appropriate we supply
information on modifying risk
(e.g. risk reduction on stopping smoking), identify patients most likely
to benefit from anti-hypertensives and statins [4,5] and make
recommendations on repeat CHD risk assessments. An unappreciated
advantage of a calculated laboratory-based CHD risk score over other
systems is the relative ease and low cost of disseminating and
implementing revised guidelines as exemplified by the fact we are now
considering incorporating advice on use of aspirin in the primary
prevention of cardiovascular disease .
We suggest that routine laboratory-based CHD risk assessment is
feasible, promotes cost-effective use of NHS resources both within the
community and hospital, and is a practical alternative to a surgery-based
computer program for assessing CHD risk.
Consultant Chemical Pathologist
1 Ramsay LE, Williams B, Johnston GD, MacGregor GA, Poston L, Potter
JF, Poulter NR, Russell G. British Hypertension Society Guidelines
for hypertension management 1999: summary. BMJ. 1999; 319; 630-635.
2.Hingorani AD, Vallance P. A simple computer program for guiding management of cardiovascular risk factors and prescribing. BMJ. 1999;318: 101-105.
3.Anderson KM, Odell PM, Wilson PWF, Kannel WB. Cardiovascular risk profiles. Am Heart J. 1991; 121: 293-298.
4.Standing Medical Advisory Committee. The use of statins. London: Department of Health, 1997.
5.Joint British Recommendations on prevention of coronary heart disease in clinical practice. Heart 1998; 80 (supplement 2): S1-S29.
Competing interests: No competing interests